Sep 17, 2015
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Hey guys,

I know there are a lot of these threads going around, but I was hoping you could offer me some advice. I'm a 4th year applying this cycle, us top 15 program, 253 step 1, 262 step 2. Grades 3rd Year were 5HP, 1H. Home EM was HP, away H, minimal research, average ECs (heavy work to volunteer ratio), and 2 SLOEs.

Anyways, I was feeling pretty good about my chances for a somewhat competitive residency (utah, ohsu, vandy, unc, etc), but they just released our MSPE one word summary and, based on overall class performance, I was 'very good'. Sadly, this translates to 14th-44th percentile (IE lower 1/3 to 1/2 of class).

As of yet, I've applied to 32 programs, mostly in popular areas (both coasts, chicago, SW) but with a HP in my home EM rotation and what now seem to be comparatively meh grades, should I be hunting for some more less-desirable locations? Or can I count on board scores and positive mspe comments to carry me?

Thanks for the input!
 
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BoardingDoc

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Hey guys,

I know there are a lot of these threads going around, but I was hoping you could offer me some advice. I'm a 4th year applying this cycle, us top 15 program, 253 step 1, 262 step 2. Grades 3rd Year were 5HP, 1H. Home EM was HP, away H, minimal research, average ECs (heavy work to volunteer ratio), and 2 SLOEs.

Anyways, I was feeling pretty good about my chances for a somewhat competitive residency (utah, ohsu, vandy, unc, etc), but they just released our MSPE one word summary and, based on overall class performance, I was 'very good'. Sadly, this translates to 14th-44th percentile (IE lower 1/3 to 1/2 of class).

As of yet, I've applied to 32 programs, mostly in popular areas (both coasts, chicago, SW) but with a HP in my home EM rotation and what now seem to be comparatively meh grades, should I be hunting for some more less-desirable locations? Or can I count on board scores and positive mspe comments to carry me?

Thanks for the input!
See carbonizedeyesockets' comment.

/thread
 

Arcan57

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I would do some soul searching to figure out why there is such a big disconnect between your success on the Steps and your success on the wards. I wouldn't worry about not matching but if you don't figure out why your clinical performance is so far below your ability to pick up information it's going to be a bumpy ride in residency.
 
OP
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Sep 17, 2015
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Is this for real?
Yes, of course. Certainly not trying to be obnoxious. I know there are people with genuine concern that they wont match, and I'm not concerned that will be me. Likewise im not trying to diminish anyone elses troubles.

I am just a bit worried I should be focusing on more out of the way programs, and that with 30 focused on places I'd rather be, I could be setting myself up for disappointment. Seems that's not the case.

Thanks for the input everyone.
 

HoosierdaddyO

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Sep 8, 2015
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I guess the real question is how bad is the grade inflation at your institution lol...to the point where you get all high passes, except for one rotation where you unfortunately we're able to squeak out an honors lol....and still you are in the quartile that you are for class rank. I recommend a federal, state and local investigation because something smells unkosher lol!! Regardless, with your stats 32 programs is more than enough. You will def get double digit interviews...stop fretting ;)
 
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OP
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Sep 17, 2015
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Yeah, I was a little caught off guard by that percentile range. I knew I wasn't top of the pack but I figured I'd be solidly in the middle, especially considering a large portion of classmates will pass at least one rotation. I guess the weighting algorithm just didn't work out in my favor.

Anyways, as to the discrepancy between scores and grades, im not sure how that happened. I ended up with very positivr MSPE comments across the board that just weren't reflected in the final grades, and the only thing can think is that I am either unusually unlucky or an exceptionally well-disguised dingus. Hopefully PDs will decide on the former.

Thanks for the reassurance.
 
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Dane07MD

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I think you need to re-evaluate your specialty choice. There seems to be an innate problem with over-worrying here with what are clearly elite level board scores. Our specialty is FILLED with uncertainty, and even the most laid back of us will still go home and perseverate about our patients who don't get a definitive diagnosis when they leave the ED. If you're losing hair or sleep over THIS, you will burn out your first month as an attending. For what it's worth, not long ago I matched at a fairly competitive residency in California with a 218 step 1, a non-honors grade at my EM home rotation and a smattering of HP/H during 3rd year.

Every applicant has at least one (often many) non-elite component of their application, so you make up for it with the other parts. And when you interview, just don't put out the serial killer vibe.

Don't get caught up in the "prestigious program" nonsense either. Find a program that is right for you, in a location you want to be, has unique components that suit your interests and go from there. Being an EM doc is not hard and training variability is minimal. Interview at 10 of the programs you are most interested in, save money by not interviewing at 14-16, and spend it on a sweet vacation at the end of fourth year. After that, you start real life and never look back. Good luck.
 

Angry Birds

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I think you need to re-evaluate your specialty choice. There seems to be an innate problem with over-worrying here with what are clearly elite level board scores. Our specialty is FILLED with uncertainty, and even the most laid back of us will still go home and perseverate about our patients who don't get a definitive diagnosis when they leave the ED. If you're losing hair or sleep over THIS, you will burn out your first month as an attending. For what it's worth, not long ago I matched at a fairly competitive residency in California with a 218 step 1, a non-honors grade at my EM home rotation and a smattering of HP/H during 3rd year.

Every applicant has at least one (often many) non-elite component of their application, so you make up for it with the other parts. And when you interview, just don't put out the serial killer vibe.

Don't get caught up in the "prestigious program" nonsense either. Find a program that is right for you, in a location you want to be, has unique components that suit your interests and go from there. Being an EM doc is not hard and training variability is minimal. Interview at 10 of the programs you are most interested in, save money by not interviewing at 14-16, and spend it on a sweet vacation at the end of fourth year. After that, you start real life and never look back. Good luck.
Good post!

[The only thing I'd humbly disagree with is the idea that "being an EM doc is not hard." I think it's incredibly hard, i.e. it is very hard work we do, which goes under-appreciated by other specialties, and we work *very* hard when we're on shift--the "density" of our hard work is greater than any other specialty. However, what makes a good EM doc is not necessarily exactly the same as what made a medical school "gunner."]
 

Cinclus

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Anyways, as to the discrepancy between scores and grades, im not sure how that happened. I ended up with very positivr MSPE comments across the board that just weren't reflected in the final grades, and the only thing can think is that I am either unusually unlucky or an exceptionally well-disguised dingus. Hopefully PDs will decide on the former.
Same thing happened to me, so I feel that same sting. Clinical grades are a real crapshoot. I have mostly HPs, a few H's, very good comments and feedback, and outstanding board scores. The honors always seem just out of reach, despite giving my all on rotations. But I think we'll both do well this season. Best of luck to you.
 
Apr 20, 2015
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I have a question about my competitiveness - i have a 260 + step 1 (step 2 pending), third year 3H and 3 HP, fourth year 3H (home EM honors) but a PASS on my EM away.... Does the pass screw me pretty hard?
 

HoosierdaddyO

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I have a question about my competitiveness - i have a 260 + step 1 (step 2 pending), third year 3H and 3 HP, fourth year 3H (home EM honors) but a PASS on my EM away.... Does the pass screw me pretty hard?
Your step 1 and clerkship grades will save your behind, curious what went so bad on the away AI. Was it you didn't gel with the program, or piss someone off lol?!
 

docdragon

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Much like the clinical Number Needed to Treat, there is a Number Needed to Match. Find out the current Number Needed to Match. Around the time you hit interview 12-16 you will be ready to get off the trail, and by about 18 you will want your head to explode just so you don't have to get on another crampy airline seat. Around that time, you will start to cancel interviews in places that you thought you might actually want to live, just because you absolutely will die in the PD's office of interview #21.

Give yourself a safe margin above the Number Needed to Match and then back way off and enjoy some of the MSIV year. And look for the place you think you FIT. There are a lot of places you will get good training and good outgoing prospects.
 
Apr 20, 2015
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Yeah I must have pissed someone off which is atypical for me - I am still puzzled honestly. I've sought out feedback to help figure out what happened.
 
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Psai

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You should retake Step 1 to increase your score to 265+ if you really want to get in.

Anyways, I hate posts like this. They are, quite frankly, obnoxious. I'm going to call every PD in the country and tell them not to accept you.
I know what you're saying but honestly it's pretty hard to tell how competitive you are and what programs to shoot for.
 
OP
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^Agreed. Yeah, I get that there are a lot of people fishing for compliments out there but mine was an honest question. I've never been the sort to talk grades and test scores with classmates because I didn't come to med school to compete, but that attitude did leave me with little idea where I stand in the pack and how best to approach applications. Couple that with an advisor thats been a bit of a fear-monger and perhaps you can understand why I came here for some other opinions.

Regardless, pretty much everyone posting here is a future colleague here. I know we're on the Internet and all but shouldn't we be giving each other the benefit of the doubt? After all, if there's one thing I'd hope I could count on from another physician, it's that they wouldn't respond to a open, genuine concern with hostility.
 
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Arcan57

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^Agreed. Yeah, I get that there are a lot of people fishing for compliments out there but mine was an honest question. I've never been the sort to talk grades and test scores with classmates because I didn't come to med school to compete, but that attitude did leave me with little idea where I stand in the pack and how best to approach applications. Couple that with an advisor thats been a bit of a fear-monger and perhaps you can understand why I came here for some other opinions.

Regardless, pretty much everyone posting here is a future colleague here. I know we're on the Internet and all but shouldn't we be giving each other the benefit of the doubt? After all, if there's one thing I'd hope I could count on from another physician, it's that they wouldn't respond to a open, genuine concern with hostility.
Burn-out is a real thing and you're going to interact with colleagues (some in EM, some in other specialties) that wouldn't feel anything about running over a puppy, so put some thought into that. Your post almost played out like a satire of the "my chance?" threads until the mediocre clinical grades. My initial response was totally sincere though. You know that your step scores weren't an accident or luck, and you should look inside yourself to find out why you didn't have that success doing clinical medicine. Your grades don't speak of "I had one rotation where I had a personality conflict with a major player and got blackballed", they speak of a pattern of failing to wow people at a place that seems to have a low bar for being impressed. The concern I didn't state in my initial post is that if your grades reflect an inability to perform up to expectations on the wards buoyed by impressive shelf exam scores, then you have internal work you need to be doing or EM is going to be miserable for you. There are amazingly smart people in EM, but it's not a specialty that rewards genius for it's own sake. We calculate risk far more often than we make a diagnosis (although this may change with ICD-10), and extreme intelligence often is accompanied by extreme confidence that distorts our perception of risk in a way that is detrimental to patient care.
 

filhodeinferno

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Hey guys,

I know there are a lot of these threads going around, but I was hoping you could offer me some advice. I'm a 4th year applying this cycle, us top 15 program, 253 step 1, 262 step 2. Grades 3rd Year were 5HP, 1H. Home EM was HP, away H, minimal research, average ECs (heavy work to volunteer ratio), and 2 SLOEs.

Anyways, I was feeling pretty good about my chances for a somewhat competitive residency (utah, ohsu, vandy, unc, etc), but they just released our MSPE one word summary and, based on overall class performance, I was 'very good'. Sadly, this translates to 14th-44th percentile (IE lower 1/3 to 1/2 of class).

As of yet, I've applied to 32 programs, mostly in popular areas (both coasts, chicago, SW) but with a HP in my home EM rotation and what now seem to be comparatively meh grades, should I be hunting for some more less-desirable locations? Or can I count on board scores and positive mspe comments to carry me?

Thanks for the input!
No chance you get in anywhere with only a 253 step I. I had a buddy with a 255 and he only got one interview total. Didn't match, scrambled into psych. He actually went crazy before he even started residency due to the stress of it all, and is actually hospitalized at the very psych facility where he would have been training at. Very ironic. Moral of the story: be VERY careful with that 253.
 
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