COMLEX Scores for Allergy/Immuno and Rheum

[PushupsForAll]

Hi. Currently 2nd year in Osteopathic med school. Interested in Allergy/Immuno and Rheum. I am aware that this is fellowship after IM.
Wanted to know how competitive it will be for a DO student. I do not plan to take USMLE, just COMLEX since I will have to do IM to reach specialization. I am just curious if anyone has info on board scores cause I can't find anything online for those fields for COMLEX scores.

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[IntheClouds4ever]

Because no one is going to care after residency. Find the pipeline residencies that feed the fellowship program for your desired sub specialty and go from there

 

[NecFasc92]

Hi. Currently 2nd year in Osteopathic med school. Interested in Allergy/Immuno and Rheum. I am aware that this is fellowship after IM.
Wanted to know how competitive it will be for a DO student. I do not plan to take USMLE, just COMLEX since I will have to do IM to reach specialization. I am just curious if anyone has info on board scores cause I can't find anything online for those fields for COMLEX scores.

What's that?

 

[Deecee2DO]

Hi. Currently 2nd year in Osteopathic med school. Interested in Allergy/Immuno and Rheum. I am aware that this is fellowship after IM.
Wanted to know how competitive it will be for a DO student. I do not plan to take USMLE, just COMLEX since I will have to do IM to reach specialization. I am just curious if anyone has info on board scores cause I can't find anything online for those fields for COMLEX scores.

No idea what comlex would be for this. Apply to IM programs with in-house fellowships that will be feeders

 

[ritts]

Hi. Currently 2nd year in Osteopathic med school. Interested in Allergy/Immuno and Rheum. I am aware that this is fellowship after IM.
Wanted to know how competitive it will be for a DO student. I do not plan to take USMLE, just COMLEX since I will have to do IM to reach specialization. I am just curious if anyone has info on board scores cause I can't find anything online for those fields for COMLEX scores.

Right now, your plan should be to get into the best IM program you can and that will lead to fellowships down the line. Step 1 will make you more competitive. Taking only Comlex may pigeon hole you to less desirable residencies. Here is the info regarding Comlex/USMLE from last year's match:

 

[trundlethegreat]

Hi. Currently 2nd year in Osteopathic med school. Interested in Allergy/Immuno and Rheum. I am aware that this is fellowship after IM.
Wanted to know how competitive it will be for a DO student. I do not plan to take USMLE, just COMLEX since I will have to do IM to reach specialization. I am just curious if anyone has info on board scores cause I can't find anything online for those fields for COMLEX scores.

The fact you're asking this question makes me think you don't have a great understanding of the process. You should probably take Step 1 so you can maximize your opportunities to match university internal medicine and then go rheum or allergy fellowship. Only need a >220. Just look at your school and tell me how many IM subspecialty faculty you have and that should be a good indicator of why you should take Step 1.

 

[Deecee2DO]

The fact you're asking this question makes me think you don't have a great understanding of the process. You should probably take Step 1 so you can maximize your opportunities to match university internal medicine and then go rheum or allergy fellowship. Only need a >220. Just look at your school and tell me how many IM subspecialty faculty you have and that should be a good indicator of why you should take Step 1.

Only a 220+ for university IM as a DO? How? lol maybe for FM and peds. For uni IM as a DO maybe im wrong but you certainly cant have a below national avg Step 1 score. Anyways i agree OP should be taking Step 1 and should aim for as high as they can

 

[Dreamstoo]

Try to match a residency with those fellowships. Otherwise, scores really do not matter in IM subspecialties unless it's GI/cardio. Let your PD know once you're in residency during your 2nd/3rd year what you're aiming for and they would most likely be more than happy to help you out.

Both these fields, allergy and rheum are quite underrated from what I hear (allergy is very part-time friendly if that's a goal of yours too, one of my friends is doing this as a mother - SO makes well over 500K).

 

[Deecee2DO]

Try to match a residency with those fellowships. Otherwise, scores really do not matter in IM subspecialties unless it's GI/cardio. Let your PD know once you're in residency during your 2nd/3rd year what you're aiming for and they would most likely be more than happy to help you out.

Both these fields, allergy and rheum are quite underrated from what I hear (allergy is very part-time friendly if that's a goal of yours too, one of my friends is doing this as a mother - SO makes well over 500K).

Well over 500 as an allergist or SO makes 500+

 

[AnatomyGrey12]

Only a 220+ for university IM as a DO? How? lol maybe for FM and peds. For uni IM as a DO maybe im wrong but you certainly cant have a below national avg Step 1 score. Anyways i agree OP should be taking Step 1 and should aim for as high as they can

220+ puts you in the running for low tier university IM.

 

[trundlethegreat]

Only a 220+ for university IM as a DO? How? lol maybe for FM and peds. For uni IM as a DO maybe im wrong but you certainly cant have a below national avg Step 1 score. Anyways i agree OP should be taking Step 1 and should aim for as high as they can

220 is going to get you in the door for some university and communiversity programs. (See minimum and average step scores below for some programs who have taken at least 1 DO, information is from Freida)

U of Arizona Pheonix: Minimum - 200; Average - 226-235
Loma Linda: Min - 200, No Average Listed
UCLA Harbor: Min - 200, Average - 226-235
George Washington: Min - 215, Average - 230
U of Florida: Min - 220, Average - 230
Wright State: Min - 200, Average - 230

Looking at the 2018 NRMP for Osteos too, only THREE people didn't match who scored over a 220, compared to the 328 who did. That doesn't differentiate between community or university, but still. Also check out the PDS:

And to drive home my point, a lot of these programs from Freida are "USMLE Only" or have 600 COMLEX L1 minimums which is 80th percentile for last year. The programs who aren't going to take DOs anyway don't care if you have a 220 or 230 anyway, and a 220 is the screening number for a lot of IM, FM, peds, and even Anesthesia and Gen Surge programs. Now, that's the bare minimum and getting a 230+ is much more desirable and minimizes risk (as you can see from averages), but this idea you need to get a 240 or you're screwed just isn't the reality. People get interviews all the time with 220+ at reputable programs and that's all Step 1 is for. That's why everyone should take it and that's why I don't agree with DO administrations telling students they shouldn't take Step 1 unless they know they are going to do really well.

That's generally speaking. If Allergy and Rheum fellowships are only at high end programs, then sure its 240 or bust. That's not something I would know and OP should look specifically into each program.

 

[Dreamstoo]

Well over 500 as an allergist or SO makes 500+

SO makes 500K+. No idea what she makes.

 

[hungrydoc710]

Advise on taking USMLE if you plan on trying to do a fellowship afterwards

 

[Dreamstoo]

Advise on taking USMLE if you plan on trying to do a fellowship afterwards

Says a medical student. No one gives a F about your test scores for fellowships. It's about how you performed in residency, who your PD knows, who you know.

 

[AlteredScale]

Says a medical student. No one gives a F about your test scores for fellowships. It's about how you performed in residency, who your PD knows, who you know.

Anecdotally, I've overheard a PD say about an applicant about how fantastic their scores were....but I have not clue if that means USMLE or board cert exams...

@PushupsForAll , take it from someone in 4th year who is applying as a COMLEX-only applicant: really try your best and have confidence in yourself to take the USMLE. If you want to do fellowship your best bet is going to a strong academic program and many of these programs will be expecting USMLE scores.

I'm not saying it's impossible. There are fellowships out there that will consider and use COMLEX scores in lieu of USMLE. It just won't be as many programs as it would be if you had step scores. Just try make your life easier down the road and really consider taking USMLE.

 

[AnatomyGrey12]

Says a medical student. No one gives a F about your test scores for fellowships. It's about how you performed in residency, who your PD knows, who you know.

I’ve had fellows tell me that it is completely specialty dependent. For stuff like Cards I’ve been told they do care and look at USMLE scores (straight from the mouth of a cards fellow), other specialties DGAF. So the real answer is: it depends and people should always do their best, and find guidance from people in the specific field they are trying to get into.

 

[Drrrrrr. Celty]

Says a medical student. No one gives a F about your test scores for fellowships. It's about how you performed in residency, who your PD knows, who you know.

This isn't exactly true. Your boards will follow you forever. They are probably still within the top 5 things that make up a fellowship application.

 

[Drrrrrr. Celty]

There's not really a good set of information on comlex for fellowship applications. Generally most people who are applying to fellowships however have average to above average usmle scores.

 

[hungrydoc710]

Says a medical student. No one gives a F about your test scores for fellowships. It's about how you performed in residency, who your PD knows, who you know.

Lol bro, if you wanna go ahead and think that fine, that's your prerogotive.
A better test score (the only real test that matters is Step 1) = a better academic residency = higher chance of being a position to get a fellow.
Understand?

 

[Epilepsy365]

Hi. Currently 2nd year in Osteopathic med school. Interested in Allergy/Immuno and Rheum. I am aware that this is fellowship after IM.
Wanted to know how competitive it will be for a DO student. I do not plan to take USMLE, just COMLEX since I will have to do IM to reach specialization. I am just curious if anyone has info on board scores cause I can't find anything online for those fields for COMLEX scores.

You will be a fantastic FM addition to a DO school opening in 10 years.

Better learn to sing the praise of AT Stills and appreciate managing diabetes, nasty feet, and non compliant CHF pts for the rest of your life.

 

[Drrrrrr. Celty]

You will be a fantastic FM addition to a DO school opening in 10 years.

Better learn to sing the praise of AT Stills and appreciate managing diabetes, nasty feet, and non compliant CHF pts for the rest of your life.

Also known as a 9 to 4 job with no call and a 250k base salary.

This not to mention that if you're actually good at what you do and you go out of your way to train yourself you'll be able to manage easily 50% of those referral patients.

 

[Epilepsy365]

Also known as a 9 to 4 job with no call and a 250k base salary.

This not to mention that if you're actually good at what you do and you go out of your way to train yourself you'll be able to manage easily 50% of those referral patients.

Money is nothing. You can make your min salary demand (whether it's 250K, 300K, or 350K) with reasonable lifestyle in any specialty. The problem is that I don't want to deal with DM and noncompliant CHF pts and write detailed notes of 8-10 problems with 4-5 ddx for each in all of my notes for the rest of my life.

I just want to be that ward wizard, write my 8-10 sentences notes, see my 6-8 pts/day, and chill the rest of the day by 3-4PM at the latest.

 

[Chibucks15]

Money is nothing. You can make your min salary demand (whether it's 250K, 300K, or 350K) with reasonable lifestyle in any specialty. The problem is that I don't want to deal with DM and noncompliant CHF pts and write detailed notes of 8-10 problems with 4-5 ddx for each in all of my notes for the rest of my life.

I just want to be that ward wizard, write my 8-10 sentences notes, see my 6-8 pts/day, and chill the rest of the day by 3-4PM at the latest.

See that’s your mindset. There’s BS in every specialty, some people tolerate different things. Personally I’ve also never seen this “chill the rest of the day by 3-4 PM” either with most subspecialties I’ve encountered but sure whatever floats your boat

 

[Dreamstoo]

Money is nothing. You can make your min salary demand (whether it's 250K, 300K, or 350K) with reasonable lifestyle in any specialty. The problem is that I don't want to deal with DM and noncompliant CHF pts and write detailed notes of 8-10 problems with 4-5 ddx for each in all of my notes for the rest of my life.

I just want to be that ward wizard, write my 8-10 sentences notes, see my 6-8 pts/day, and chill the rest of the day by 3-4PM at the latest.

Definitely doable without a preference of where you want to live. No way someone in the NE would pay a PCP 250K for that type of schedule you want though. I'm aware of a solo PCP who has to see about ~25 patients a day to make the 250K with overhead every year. Same person works 50 hours in office and easily 10+ hours taking care of paperwork.

 

[Epilepsy365]

See that’s your mindset. There’s BS in every specialty, some people tolerate different things. Personally I’ve also never seen this “chill the rest of the day by 3-4 PM” either with most subspecialties I’ve encountered but sure whatever floats your boat

All of my Neuro attendings peace out by 4 PM at the latest. That's my observation from being at three university training programs.

So, you're either at a malignant place or those people are making a crap ton of cash.

 

[Dreamstoo]

All of my Neuro attendings peace out by 4 PM at the latest. So, you're either at a malignant place or those people are making a crap ton of cash.

Out of curiosity, which part of the States? Even in the NE major city I live in, it does seem neurology seems more lifestyle friendly residency than most.

 

[Epilepsy365]

Out of curiosity, which part of the States? Even in the NE major city I live in, it does seem neurology seems more lifestyle friendly residency than most.

Neurology residency is pure pain throughout training. But, life as an attending is very lucrative and chill.

Academic places in Midwest/West Coast.

 

[Drrrrrr. Celty]

Money is nothing. You can make your min salary demand (whether it's 250K, 300K, or 350K) with reasonable lifestyle in any specialty. The problem is that I don't want to deal with DM and noncompliant CHF pts and write detailed notes of 8-10 problems with 4-5 ddx for each in all of my notes for the rest of my life.

I just want to be that ward wizard, write my 8-10 sentences notes, see my 6-8 pts/day, and chill the rest of the day by 3-4PM at the latest.

.... are you a second year or something? Specialist/consults are almost always part of groups. They don't see 6-8 pts a day. They see 6-8 pts a day at 2-3 different hospitals or they're outpatient clinic in the afternoon or morning.
Also no one writes 8-10sentence notes. If you're consulted on an inpatient unit then chances are there is something complicated that the primary team needs guidance on. I.e I need you to figure out whether this patient's presentation correlates to x. Which requires time to preform exam, chart, and then write a note.

This not to mention that this doesn't even begin to reflect the more intensive subspecialties or consults ex. cardio. Where even on top of doing caths, procedures, you're still writing down **** like how HLD, HTN, etc random history needs management and follow.

 

[Dreamstoo]

Neurology residency is pure pain throughout training. But, life as an attending is very lucrative and chill.

Academic places in Midwest/West Coast.

Yeah it may be chill. But I can't imagine dealing with that patient population. Can't imagine how depressing it can be. Granted the neurology resident I know was gun-ho about neurology from the day one of freshman at a top 5 undergrad. Absolutely loves his job.

 

[Drrrrrr. Celty]

All of my Neuro attendings peace out by 4 PM at the latest. That's my observation from being at three university training programs.

So, you're either at a malignant place or those people are making a crap ton of cash.

I'm pretty sure I woke my on call neurologist from bed around 3 times last night while I was on icu call. And I've contacted multiple times during family dinners or lunches to have them come in on the weekend multiple times to evaluate eegs and unprovoked seizures or strokes.

If you're associated with a hospital, then you have call. And if you have call, then your life is never your own. And their notes btw are some of the longest I've read outside of Psych, which well... write everything word for word.

 

[Epilepsy365]

.... are you a second year or something? Specialist/consults are almost always part of groups. They don't see 6-8 pts a day. They see 6-8 pts a day at 2-3 different hospitals or they're outpatient clinic in the afternoon or morning.
Also no one writes 8-10sentence notes. If you're consulted on an inpatient unit then chances are there is something complicated that the primary team needs guidance on. I.e I need you to figure out whether this patient's presentation correlates to x. Which requires time to preform exam, chart, and then write a note.

This not to mention that this doesn't even begin to reflect the more intensive subspecialties or consults ex. cardio. Where even on top of doing caths, procedures, you're still writing down **** like how HLD, HTN, etc random history needs management and follow.

MSIV. If you're writing more than 10 sentences as a specialist on the majority of your consults, you suck at your job, unless you're a Psychiatrist. LOL. That's a diff story altogether.

 

[Dreamstoo]

MSIV. If you're writing more than 10 sentences as a specialist on the majority of your consults, you suck at your job, unless you're a Psychiatrist. LOL. That's a diff story altogether.

Yo do realize you're a medical student making this statement? And I'm pretty sure Celty is a resident.

 

[Chibucks15]

MSIV. If you're writing more than 10 sentences as a specialist on the majority of your consults, you suck at your job, unless you're a Psychiatrist. LOL. That's a diff story altogether.

I’m a third year on a subspecialty and my notes are longer than that. If that’s how short yours are I don’t think they’re as good as you think they are...

The residents and attendings at my place are way over that because they have to include BS for billing purposes. When I tried to shorten them it just made more work for them later on

 

[Epilepsy365]

I’m a third year on a subspecialty and my notes are longer than that. If that’s how short yours are I don’t think they’re as good as you think they are...

The residents and attendings at my place are way over that because they have to include BS for billing purposes. When I tried to shorten them it just made more work for them later on

Long notes don't mean better. You're still working on your note writing. Keep at it and you will figure out your style. I haven't been told of any deficiency in my note writing after X-mas of third year.

I have seen plenty of IM notes that are very long. Nobody read that junk, even at the attending level.

 

[Dreamstoo]

Long notes don't mean better. You're still working on your note writing. Keep at it and you will figure out your style. I haven't been told of any deficiency in my note writing after X-mas of third year.

I have seen plenty of IM notes that are very long. Nobody read that junk, even at the attending level.

So you know more than a relative of mine whose a former IM hospitalist who also happens to have taught residents at one point? Because this is so wrong in so many ways. You miss a finding in an IM report you could risk a missed diagnosis that could be life threatening AND career threatening.

 

[Epilepsy365]

So you know more than a relative of mine whose a former IM hospitalist who also happens to have taught residents at one point? Because this is so wrong in so many ways. You miss a finding in an IM report you could risk a missed diagnosis that could be life threatening AND career threatening.

You will soon realize that a lot of people in medicine are bad at writing and think that a long paragraph with 15-20 sentences is equivalent to being thorough and doing a good job, especially at the medical student and junior resident levels.

Read a note written by a senior resident vs an intern and see a difference. And no. Writing 15-20 sentences on a problem when you can convey the same essential info in 4-5 sentences is a poor reflection on you. I have rotated through both Cardiology and Neurology services, staffed by attendings from elite places like Columbia/UCSF/Stanford. I'm telling you that their notes are rarely over 10 sentences, especially on a focused Neurology or Cardiology problem.

If my notes are complete trash, I would get plenty of feedbacks about them by now. All feedbacks have been "superb notes with minimal revision."

 

[Dreamstoo]

You will soon realize that a lot of people in medicine are bad at writing and think that a long paragraph with 15-20 sentences is equivalent to being thorough and doing a good job, especially at the medical student and junior resident levels.

Read a note written by a senior resident vs an intern and see a difference. And no. Writing 15-20 sentences on a problem when you can convey the same essential info in 4-5 sentences is a poor reflection on you. I have rotated through both Cardiology and Neurology services, staffed by attendings from elite places like Columbia/UCSF/Stanford. I'm telling you that their notes are rarely over 10 sentences, especially on a focused Neurology or Cardiology problem.

If my notes are complete trash, I would get plenty of feedbacks about them by now. All feedbacks have been "superb notes with minimal revision."

Seems you callously don't care much for the important for detailed notes from primary care doctors and just want the lifestyle of being a doctor. To each his own.

 

[Epilepsy365]

Seems you callously don't care much for the important for detailed notes from primary care doctors and just want the lifestyle of being a doctor. To each his own.

You're not getting it. Reread this thread in 5 years.

You're quick to a lot of assumptions.

And, primary care doc notes are the worst. On many occasions that's equivalent to MS3 level note.

 

[Dreamstoo]

You're not getting it. Reread this thread in 5 years.

You're quick to a lot of assumptions.

And, primary care doc notes are the worst. Complete ass on many occasions that's equivalent to MS3 level note.

Wow so my relative whose saved lives is equivalent to an over glorified MS3 scribe?

 

[Dreamstoo]

Apparently so bc you say it yourself.

Can't wait in 10 years when you end up in primary care and get sued a **** ton for laziness.

 

[AlteredScale]

Hey guys and gals, reminder to keep the conversation professional. Even if we disagree with a practice style, it's really not necessary to denigrate other specialties. Thanks.

 

[Chibucks15]

You're not getting it. Reread this thread in 5 years.

You're quick to a lot of assumptions.

And, primary care doc notes are the worst. On many occasions that's equivalent to MS3 level note.

I’m literally doing notes with the template from the senior resident...it isn’t about my style, it’s about what’s in the note so it can be covered by insurance so the patient doesn’t have headaches to deal with outside of the hospital. whatever best of luck I’ve never seen a note that short from any specialty at my hospital. I’ll keep doing it this way

 

[Dr.Bruh]

Only a 220+ for university IM as a DO? How? lol maybe for FM and peds. For uni IM as a DO maybe im wrong but you certainly cant have a below national avg Step 1 score. Anyways i agree OP should be taking Step 1 and should aim for as high as they can

220 is not bad for many Midwest Uni IM programs. My old roommate got Uni IM with a 210 and 3 preclinical failures. She got lots of interviews to.

 

[Drrrrrr. Celty]

You will soon realize that a lot of people in medicine are bad at writing and think that a long paragraph with 15-20 sentences is equivalent to being thorough and doing a good job, especially at the medical student and junior resident levels.

Read a note written by a senior resident vs an intern and see a difference. And no. Writing 15-20 sentences on a problem when you can convey the same essential info in 4-5 sentences is a poor reflection on you. I have rotated through both Cardiology and Neurology services, staffed by attendings from elite places like Columbia/UCSF/Stanford. I'm telling you that their notes are rarely over 10 sentences, especially on a focused Neurology or Cardiology problem.

If my notes are complete trash, I would get plenty of feedbacks about them by now. All feedbacks have been "superb notes with minimal revision."

No one is saying write 15 sentences per problem. However chances are you want to explain and detail what has happened, what the current plan is, and corroborating findings. Sometimes that can be as simple as Legionella and step antigen negative, bcx + 1/2 h. influ - treat with x, consult x. Probably for the first 3-4 problems you only need 2-5 sentences. Then afterward it's literally continue home meds.
Alternative you can have completely complicated patients who truly mixed presentations which actually validate their need for inpatient hospitalizations and will have the first 3 problems with a couple of paragraphs.
Regardless, writing the note is rarely the hard part. Chart searching for obscure history between 3 difference hospital systems to corroborate what has been done, what inplants they have, which mri to use, or what diagnoses have been made in the past is where you'll sink in your time.

 

[Drrrrrr. Celty]

You're not getting it. Reread this thread in 5 years.

You're quick to a lot of assumptions.

And, primary care doc notes are the worst. On many occasions that's equivalent to MS3 level note.

Some can be very straight forward and problem guided. I think generally most outpatient notes rarely require significant extraneous details. If you're a subspecialist you're being consulted to answer a question or to manage a set of problems. If you're generalist it's often copy forward and focus on 2-3 problems per visit and refill meds. The tempo doesn't require intensity, you can and should tell the person to come visit at another time if multiple problems exist.

 

[Drrrrrr. Celty]

Long notes don't mean better. You're still working on your note writing. Keep at it and you will figure out your style. I haven't been told of any deficiency in my note writing after X-mas of third year.

I have seen plenty of IM notes that are very long. Nobody read that junk, even at the attending level.

Tbh sometimes I feel like some of the consults just copy and paste chunks of my notes because I am thorough. So I don't think ppl aren't reading long notes. Truth be told a long note that communicates treatment course is great. A simple one can do that too though. But other times ex. off service residents like EM on wards you're basically going to have to rewrite the note after them because the loss of detail inhibits treatment course and understanding of what has been thought through.

 

[Deecee2DO]

220 is not bad for many Midwest Uni IM programs. My old roommate got Uni IM with a 210 and 3 preclinical failures. She got lots of interviews to.

Thats great to hear. Def not willing to move to the midwest but wow a 210 and 3 preclinical failures as a DO and still matched uni IM-speechless lol

 

[Dr.Bruh]

Thats great to hear. Def not willing to move to the midwest but wow a 210 and 3 preclinical failures as a DO and still matched uni IM-speechless lol

Even more wild is this person wanted Med/Peds but dropped on their match list to IM (dual applied) but after intern year was able to snag a spot at Georgetown without having to reapply though the match and just integrated in as a Pgy2.

 

[hungrydoc710]

Does univ IM increase the fellowship chances?
Is that the positive factor vs comm IM?

 

[AlteredScale]

Does univ IM increase the fellowship chances?
Is that the positive factor vs comm IM?

Yes for a number of reasons:
- in house fellowship at own program increases chances being on the "home team"
- more opportunities for research normally at university IM programs, better infrastructure usually with having in house staff to run the stats for you

Now, there are still many many people matching fellowship from community programs because:
- many community programs have their own in house fellowship, but usually not a large array as what's found at a university program
- based on ACGME requirements, every residency program must have ongoing scholarly activity, so research opps are going to be there in some manner

The take home so far for this post is that as a DO, you are fighting an uphill battle in entering strong, academic, university programs for IM. This intrinsically will make entering fellowship harder IF you don't get into a program (community or university) that will support your endeavors and/or has a track record of sending people into fellowship. You can make your life easier entering academic IM by trying to accomplish the following:
-getting strong grades preclinical and reaching for SSP (the DO's version of AOA)
-scoring well on BOTH USMLE and COMLEX, skies the limit.
-doing well in your clerkships and honoring your shelves
-getting strong letters from attending with faculty appointments
-demonstrating interest in scholarly activity with hopefully some sort of output (at minimum, presenting your work at the schools conference)

Obviously, not everyone can achieve all these and that's absolutely fine. Just being unique can really help you stand out, do the extra curricular stuff you find interesting. if you like volunteering do it. if you like music or the arts do something with it.