Exactly how hard is it to get into a top residency program?

[auburnO5]

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And what do the programs take into consideration when you are interviewing?

 

[VOP]

STEP1, STEP1, STEP1, STEP 1, LORs, Clinical year grades, AOA, RESEARCH(Publications), Basic Science year grades, Shadowing, good looks, how many women you hooked up with

 

[bobsmith]

Depends on the specialty but in general, the most important things are clerkship grades, board scores, AOA and LORs. Preclinical grades are less important, school reputation is less important and research is important depending on what specialty you're going into.

Some (potentially) helpful images:

edit: something happened to the images, you can get 'em here: http://journals.lww.com/academicmed..._Criteria_for_Residency__Results_of_a.24.aspx

 

[auburnO5]

Thanks for your responses, what is AOA?

 

[Law2Doc]

...Obviously grades from MS1 and 2, ...

Um no. This is perhaps the least important thing on the list so hardly "obviously". Too many programs give P/F during the first year so it's hard to compare schools, so they usually don't bother.

Program directors will focus on (1) Step 1 grades, (2) your 3rd and 4th year rotation evaluations, (3) how you did on away rotations, (4) LORs and connections, (5) publications, and so on. MS1 and 2 are only really important insofar as they prepare you for Step 1, and to the extent they play into AOA selection or class rank. Folks overestimate the importance of these grades because it's the only thing they have to distinguish themselves during these years, and because they are still locked into the undergrad grade oriented mentality, but the truth of the matter is that if you do well on Step 1 and your clinical years, you are golden.

 

[Morsetlis]

That LOR from the Dean is gonna have your class rank, which is tied to your class grades ;p

 

[VOP]

Thanks for your responses, what is AOA?

http://www.alphaomegaalpha.org/

 

[lacrossefiend73]

That LOR from the Dean is gonna have your class rank, which is tied to your class grades ;p

Not sure about other schools, but think it might be similar to my school... no where in our dean's letter does it say "so and so was # out of #". The most it says was "so and so passed all his/her preclinical courses" and then maybe what quartile of the class you were in.

 

[drizzt3117]

In the end, everything matters, but if you go to the eras site and look at the info on what goes into the dean's letter, you'll have a better idea of how it all goes. Preclinical grades are important simply in terms of class rank / aoa.

 

[rama kandra]

what I am about to say will shock and chagrin...

Connections.

 

[45408]

what I am about to say will shock and chagrin...

Connections.

What type of residency did you get into?

 

[thesauce]

What type of residency did you get into?

Burn...

 

[J ROD]

http://www.alphaomegaalpha.org/

Med school honor society....

 

[J ROD]

Getting into top residencies is probably near the same difficulty of getting into top med schools.....probably a little harder

worry about board scores, clinical grades, great LORs, connections

 

[LaCasta]

How does one do well in the clinical years?

How are you evaluated?

 

[Narmerguy]

Getting into top residencies is probably near the same difficulty of getting into top med schools.....probably a little harder

worry about board scores, clinical grades, great LORs, connections

I imagine it's harder since your field of competition is significantly more capable than at the last stage.

 

[thesauce]

How does one do well in the clinical years?

How are you evaluated?

Subjectively. Along with exams for each rotation (at some schools).

 

[Skyrockavatar]

Yeah I heard you need to get closer to the head of deps. of ur residency and show them ur worthy during clinicals. That plays a big role too. connections....agreed

 

[thesauce]

And what do the programs take into consideration when you are interviewing?

Well, the interview is a different beast than the application itself. The interview is mainly there to screen for personality disorders and see if you're a good fit. The programs already have you ranked in some way before the interview and the interview is just one of many criteria they use in selection.

As for the application itself: step 1 certainly matters. The median score for the most competitive specialties is around a 240, which is about 85th percentile. As mentioned by another, this is out of people that scored an average of 80-85th percentile on the MCAT to get admitted in the first place. That being said, it isn't THAT hard to do if you put in the effort.

Grades and AOA differ from school to school, so I won't comment on that. Research is very important for certain specialties (radonc, plastics) and not so much for others.

 

[SouthernSurgeon]

That LOR from the Dean is gonna have your class rank, which is tied to your class grades ;p

Well the thing there is that the Dean's letter really doesn't matter much (another big secret in this process). All dean's letters (also called MSPE) are released on November 1st.

By that time I had already heard back from nearly 3/4 of my programs - none of them waited on or cared about the info in the letter.

Also some schools don't do "true" class rankings but rather break you in groups, quartiles, etc...

 

[weightyheart]

Well the thing there is that the Dean's letter really doesn't matter much (another big secret in this process). All dean's letters (also called MSPE) are released on November 1st.

By that time I had already heard back from nearly 3/4 of my programs - none of them waited on or cared about the info in the letter.

WHAT the.....is this true? Can I get a second opinion on this?

 

[typhoonegator]

Well the thing there is that the Dean's letter really doesn't matter much (another big secret in this process). All dean's letters (also called MSPE) are released on November 1st.

By that time I had already heard back from nearly 3/4 of my programs - none of them waited on or cared about the info in the letter.

Also some schools don't do "true" class rankings but rather break you in groups, quartiles, etc...

Agree with that. Particularly for early match specialties, they've already scheduled all their interviews and met most of the applicants by the time the MSPE comes out. It can hurt you if your board scores were good and your MSPE is poor, but after they've met you they're going to put more stock in what they've seen than what some Dean of Student Affairs has written. An MSPE that ranks you in the top 1% of your class might help push you over the edge if they're otherwise on the fence about you, but it will not hit a home run for you.

 

[thesauce]

WHAT the.....is this true? Can I get a second opinion on this?

I only heard back from 2 programs before the dean's letter was released. One PD even told me that the MSPE is the first thing she looks at.

To the prior poster's credit, this is highly specialty specific. My specialty does things later than most.

 

[SouthernSurgeon]

WHAT the.....is this true? Can I get a second opinion on this?

As mentioned above; it is somewhat specialty specific.

The PD at my program said that (a) the info comes out so late it does him little/no good and that (b) it is largely redundant information (i.e. he gets all he needs from our transcripts, board scores, LORs, AOA status).

Here is a nice quote from a journal article on the subject: (Green M, Jones P, Thomas JX Jr. Selection criteria for residency: results of a national program directors survey. Acad Med. 2009 Mar;84(3):362-7)

The MSPE was ranked lowest of all criteria by the program directors. In theory, MSPEs should provide most of the information that program directors value. However, MSPE usefulness may be limited by variability in content and quality across institutions. Additionally, information included in the MSPE can be acquired through the transcript, USMLE score report, ERAS application, or letters of recommendation. Finally, the MSPE release date of November 1 may be too late to be useful to program directors, particularly for early match specialties. Given the enormous effort that goes into the creation of the MSPE, it may be worth further study to assess why program directors do not find it useful and to judge whether the resources required to create it are justified.

Now obviously it matters some - if you have a glaring deficiency or poor evaluation the MSPE may be the place where this gets disclosed.

But if you are a solid applicant with no big flaws - you are going to get almost or all your interviews offered before the MSPE even gets seen by a program. At that point they aren't going to get too excited the content since with the exception of class rank and some of your evaluation comments the information really isn't "new". And unless that stuff is in the very extreme ranges (i.e. class rank in the top or bottom decile) it's probably not going to be a big factor in the final consideration of your application..

 

[Infinitydrop]

So school reputation is really not that important? what about URM or ORM status? Is general surgery considered a very competitive speciality?

 

[SouthernSurgeon]

So school reputation is really not that important?

This is debated constantly with no good consensus answer. See the 8 million prior threads on the issue.

what about URM or ORM status?

Still probably matters, probably not as overtly as at the med school admissions level.

Is general surgery considered a very competitive speciality?

General surgery is average to slightly-above-average competitiveness, but it is on a bit of an upswing at the moment. It is important to realize that even within the "non-competitive" fields there are still very competitive programs (i.e. to match at a top program like MGH or Johns Hopkins in surgery you have to have stats that rival those of an ortho or plastics or derm applicant)

 

[thesauce]

But if you are a solid applicant with no big flaws - you are going to get almost or all your interviews offered before the MSPE even gets seen by a program.

I would tend to agree with most of the PD's that the MSPE isn't especially useful considering all of the other information they have. It essentially includes a compilation of 3rd year attending comments written in haste and other academic information they already have. Particularly with Ophtho and Uro (since they match early), it probably doesn't factor in at all.

I will reiterate, however, that my specialty sent out only a small fraction of interview offers before November 1st. I don't usually like to quote the outliers, but I've heard that derm and plastics are like this, too. Even in these cases, I seriously doubt (as the journal article would suggest) that the letter would make much of a difference in how they evaluate you.

 

[FluffyRabbit]

General surgery is average to slightly-above-average competitiveness, but it is on a bit of an upswing at the moment. It is important to realize that even within the "non-competitive" fields there are still very competitive programs (i.e. to match at a top program like MGH or Johns Hopkins in surgery you have to have stats that rival those of an ortho or plastics or derm applicant)

This may be kind of premature, but how helpful is it to come from said programs when applying for fellowships? What else do they look at given you don't really have transcripts or AOA or any of that stuff at that point?

 

[45408]

WHAT the.....is this true? Can I get a second opinion on this?

Same. I got most of my interview offers before the MSPE came out.

So school reputation is really not that important? what about URM or ORM status? Is general surgery considered a very competitive speciality?

No, it's not. I just finished applying for it, and most of my classmates who were also going for GS had no trouble getting plenty of interviews. My friends going for ortho and plastics were having a much harder time getting as many interviews. Surgery is more competitive than medicine or pediatrics, and it's about on par with anesthesia or emergency medicine.

This may be kind of premature, but how helpful is it to come from said programs when applying for fellowships? What else do they look at given you don't really have transcripts or AOA or any of that stuff at that point?

They can look at your case volume (how many surgeries you've done), your ABSITE scores (taken every January of your residency), research you've done, conferences you've presented at, LORs, interviews, etc.

If you have a particular competitive specialty in mind, like surg onc or pediatrics, you should probably not go to a residency that has never matched someone into that field. Peds surgery is insanely competitive - there's only 40-50 spots per year - and it's pretty much a given that you have to do 2 years of research to get any interview offers.

As for picking a program - if you want to go into academics, you should go to an academic program. If you want to do private practice, it might be better to do a community program where you will probably operate more and see more "bread and butter" surgery cases. Doing liver transplants on babies in residency isn't really relevant to 99% of surgeons, but if you want to do them, you should definitely be going to an academic center. On my interview trail, more than once, a highly specialized surgeon at a large academic center said "Oh, if I needed my gall bladder out, I'd go see the general surgeons at that outside community hospital."

If you have a particular region of the country in mind as your final destination, you should probably do your residency there. Grand Rapids is a surgery program with a very good reputation in the Midwest, but it's not one of the things that SDN pre-meds tend to pick up on in a match list 😉 If you want to end up in Bah-stin, you should probably go somewhere on the east coast, so the people interviewing you for a fellowship/job will know about your training.

 

[FluffyRabbit]

They can look at your case volume (how many surgeries you've done), your ABSITE scores (taken every January of your residency), research you've done, conferences you've presented at, LORs, interviews, etc.

If you have a particular competitive specialty in mind, like surg onc or pediatrics, you should probably not go to a residency that has never matched someone into that field. Peds surgery is insanely competitive - there's only 40-50 spots per year - and it's pretty much a given that you have to do 2 years of research to get any interview offers.

As for picking a program - if you want to go into academics, you should go to an academic program. If you want to do private practice, it might be better to do a community program where you will probably operate more and see more "bread and butter" surgery cases. Doing liver transplants on babies in residency isn't really relevant to 99% of surgeons, but if you want to do them, you should definitely be going to an academic center. On my interview trail, more than once, a highly specialized surgeon at a large academic center said "Oh, if I needed my gall bladder out, I'd go see the general surgeons at that outside community hospital."

If you have a particular region of the country in mind as your final destination, you should probably do your residency there. Grand Rapids is a surgery program with a very good reputation in the Midwest, but it's not one of the things that SDN pre-meds tend to pick up on in a match list 😉 If you want to end up in Bah-stin, you should probably go somewhere on the east coast, so the people interviewing you for a fellowship/job will know about your training.

Now I'm curious. 🙂

As far as I have heard, medical school reputation plays a role in residency matching, but it's far less important that other things such as board scores, clinical grades and LoRs, making it such that any one who does well at any school has a good shot at a top residency.

Apart from the regional bias, is this true for fellowships? For example, if someone does his IM residency somewhere not as well regarded, is there any hope of doing cards/GI/onc?

 

[tinery]

How do med students go about making the connections that are supposedly so important for getting into good residencies?? Who do you make connections with, when, and how?

I can't imagine just chatting up a program director and asking if he/she would like to hang out or something...

 

[thesauce]

How do med students go about making the connections that are supposedly so important for getting into good residencies?? Who do you make connections with, when, and how?

I can't imagine just chatting up a program director and asking if he/she would like to hang out or something...

Common times that connections are made:
1. Summer after 1st year (research/shadowing)
2. In 3rd year, during rotations/electives
3. In 4th year, during electives/away rotations

You'll rarely get a "buddy-buddy" relationships with the PDs/Chairs (although you may), but you really want a good letter of rec and maybe a phone call.

 

[Law2Doc]

...
Apart from the regional bias, is this true for fellowships? For example, if someone does his IM residency somewhere not as well regarded, is there any hope of doing cards/GI/onc?

Well, the problem is that you are very subjectively evaluated once you finish school. There are still boards and in-service exams, which play some role, but how you did as a resident and good attending word of mouth, as well as significant research and publications, certainly plays a bigger role in landing a fellowship than coming from school to a residency. I'd say you definitely would want to ask residencies how they do in terms of placement into fellowships, because it's not like residency where they just look so heavilly at an objective yardstick like Step 1 in giving out interviews.

 

[45408]

How do med students go about making the connections that are supposedly so important for getting into good residencies?? Who do you make connections with, when, and how?

I can't imagine just chatting up a program director and asking if he/she would like to hang out or something...

At least at my school, it was significantly easier than I thought. When I decided to go for gen surg, I simply approached a surgeon I'd worked with before. I was on anesthesia and ran into her, so I asked if we could meet and talk about residency options. She was more than willing, so I met with her, and she recommended meeting with another surgeon. I e-mailed that surgeon and said I had met with the prior one and would like to talk. She agreed as well, gave me lots of good information, then recommended sitting down with the lead surgeon on the team I was going to be on for my surgery sub-I. He agreed right away as well, and when I met with him, he offered to let me follow him closely for the entire month. Bam. Done.

Just talk to people and express interest. They usually WANT to help you.

 

[Morsetlis]

You were thinking of Fellowship while doing rotations? That's some serious foresight.

 

[BlueElmo]

No, it's not. I just finished applying for it, and most of my classmates who were also going for GS had no trouble getting plenty of interviews. My friends going for ortho and plastics were having a much harder time getting as many interviews. Surgery is more competitive than medicine or pediatrics, and it's about on par with anesthesia or emergency medicine.

So what were some of the general profiles/stats for you and your classmates who applied for GS, if you don't mind my asking?

 

[Infinitydrop]

I am also curious more about GS. I do notice that the number of people that go into surgery is very small % of the class, which is interesting because so many premeds I know are interested in the surgery options. So I have always thought that maybe it was because surgery was very difficult to get into specialty.

 

[45408]

So what were some of the general profiles/stats for you and your classmates who applied for GS, if you don't mind my asking?

My Step 1 and Step 2 scores were above the average for surgery, I was in the top 3rd of my class (based on my dean's letter), I high passed my M3 surgery rotation but had good comments, and I honored my surgery sub-I. No research, minimal academic ECs.

I am also curious more about GS. I do notice that the number of people that go into surgery is very small % of the class, which is interesting because so many premeds I know are interested in the surgery options. So I have always thought that maybe it was because surgery was very difficult to get into specialty.

You could fill every surgery spot in the US with 6% of US allo grads. Don't forget that OB/gyn, urology, ortho, ENT, and neurosurg are all surgical specialties too. Anesthesia will also keep you in the OR all day too.