Game plan for MD/PhD student

[phonyreal98]

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Hi all,

It'll be a long time before I apply to residency, but I just wanted to post here to see if y'all could help me game plan for the next 5 years or so. I am primarily interested in psychiatry, and while my numbers aren't great, I think that I have a decent narrative that paints me as somebody wanting a career as a psychiatrist-researcher.

I am an MD/PhD student, and my pre-clinical years of med school, while not a complete disaster, were pretty lackluster. I am in the bottom 25% of my class (got a low pass in our very first class, anatomy, but passed everything else----no high passes or honors), and to cap it off, I found out that I got a 212 on Step 1 yesterday. However, since I'm an MD/PhD, my strength is research. I have 4 publications and several abstracts and I'm just starting my PhD (literally starting this week). I think I have one other publication working its way through the review process right now. The kicker for this is that literally all of my research, dating back to undergrad, is psych related. My PhD research will be doing functional neuroimaging in a variety neurodevelopmental disorders. I am thinking of doing a child/adolescent or neuropsychiatry fellowship after finishing residency.

My gameplan for the rest of time in my program:
1- Do well on rotations when I return to med school (duh), on rotations other than psych, learn as much as I can and make SURE that psych is what I want to do. Nothing worse than committing to something and then realizing 6 months later I should have done something else.
2- Try and figure out why my first two years of med school have been fairly mediocre, see if I can think of/implement any solutions to this, and do better on Step 2. (I have trouble with the massive amounts of memorization with med school...I also had problems with adapting to the massive numbers of instructors and teaching styles during pre-clinical years)
3- Kick butt as a graduate student. Publish, get grants, present at conferences, etc. My research is directly applicable to psychiatry and my PI seems to be well known in psychiatry research circles (one of my PI's papers is listed in splik's "100 Papers in Clinical Psychiatry" thread). I assume a great LOR from this person can help support the narrative I'm trying to weave for myself.
4- Tying together numbers 1 and 3, get good letters of rec from my PI and attendings during 3rd and 4th year
5- Go to conferences and network in the field. In addition to neuroscience conferences, I should have the opportunity to attend several psychiatry conferences (I'm pretty sure I'll have the chance to go to Biological Psychiatry, and possibly a few others).


Some questions-
As it stands now, will my Step 1 score get me screened out at any programs? I realize it's not necessarily a disaster of a score for psych, but it's below average. Is there a ballpark step 2 score I should be shooting for?

How far will my research experience/PhD and overall narrative of wanting to be a psychiatrist-researcher go in mitigating the potential effects of my mediocre step 1 score?

How much will networking in the field help me? I feel like I have a fairly extensive network of contacts (for this point in my career) at all levels (residents, attendings, and researchers) in several departments I am looking at. Will being somewhat well-connected in the research world help me if I want to pursue a research track during residency? Should I consider an away rotation at a program that might otherwise be a reach for me?

Any suggestions on programs to look at? I am looking for somewhere where I will get solid clinical training (why do a residency if I don't actually want to be a physician?) as well as have the opportunity to work with successful researchers in order to advance my research career. As far as location, I would prefer somewhere in the south or midwest (grew up and went to undergrad in the south, med school and grad school in the midwest). I am willing to sacrifice on location, if need be. I also don't care much if it's a "name brand" program (whatever that means) provided that I'll get solid training as a clinician and psychiatry researcher.

Lastly, anything to add (or subtract) from my plan?

 

[Bartelby]

1 - I don't think that 212 will screen you out anywhere.
2 - Your PhD with multiple psych-related publications will go a very long way with good programs. Dedicated psychiatric researchers (MD/PhD) are not easy to find.
3 - Networking might help, especially if people you know well are in touch with researchers at your target programs. I think an away could be good if you are confident you will shine clinically. If not, an away would just hurt you.

Overall you have a weak-ish pre-clinical track record though without any real red flags, and the pre-clinical years are the least important. The 212 should not keep you out of anywhere. I would recommend doing your best to bring in good clinical clerkship grades (especially honors in psych, if possible in IM, surgery, and peds). Getting a high step 2 is nice but probably not super important.

The takeaway is we are glad to have someone like yourself who is interested in research coming into the field! I think that assuming you do well in your clinicals and get a reasonable (does not have to be stellar) step 2 score that you are in the running for the best programs in the country, and should do quite well in the South/Midwest if that is what you want.

 

[clausewitz2]

I had a similar experience as someone who did the PhD thing prior to med school - I utterly failed to set the world on fire in my preclinical years and got super demoralized, topped by a step 1 score a bit lower than I wanted. Then I got to clinical rotations and everything went much better than expected. I have had only positive evals third year, and felt the incredibly thick skin and thinking on my feet skills that graduate school gave me were critical in that. So it is definitely possible that you will shine on wards!

 

[jjmack]

I don't think your score will automatically screen you out of any programs it will definitely make it more difficult to match at the "top" programs. Also since you'll be applying in a number of years after grad school average step 1 scores are creeping up so it'll make all MD, PhD students scores look worse than they really are. I'd post in the MD/PhD forum for some other MD/PhD views. Good luck.

 

[psychattending]

I suspect that you won't have a problem getting interviews at most academic places. Where you end up on the rank list will likely depend on how you come off during the interview and how well you do on your clinical rotations. For now I would not spend time worrying about things. Just try to do well both in research and your clinical rotations. Once you get closer to applying to programs is the time to then begin to really think about where to apply and how competitive you will be.

 

[phonyreal98]

Good to hear, thanks everybody!

 

[shan564]

Sounds like WashU would be perfect for you for several reasons:

1. Step 2 score is weighed more heavily than Step 1 score. I can't give you a specific number to shoot for, but if you're above average, you'd probably be a very strong candidate because of my next point:
2. Research experience and/or PhD is weighed heavily, so your PhD and your specific research experience will probably outweigh your Step 1 score.
3. If you asked me to list the program's biggest research strength in 5 words, I'd probably say "functional neuroimaging of neurodevelopmental disorders."
4. You like the Midwest, and St. Louis is one of the most Midwestern of all cities.
5. Great child/adolescent fellowship with faculty who are leading experts particularly in functional neuroimaging and/or neurodevelopmental disorders.
6. We don't have a neuropsych fellowship, but we have a lot of neuropsychiatry, including a multidisciplinary movement disorders fellowship that's open to psychiatrists, although it's primarily neurologists. We have one of the world's leading centers in Huntington's Disease, dementias, and epilepsy. This is one of the few places where you're likely to manage multiple Huntington's patients (from a psychiatric perspective) during residency. We also have some great researchers/clinicians in tic disorders, MS, and various other neuropsychiatric disorders. Our department chair is an expert in NMDA receptors, and there's been a huge grown in training on NMDA-related neuropsychiatric disorders; I saw a couple of anti-NMDA receptor encephalitis patients on my 2-month psych consults rotation. There's also a lot of mutual respect between the neurologists and the psychiatrists, since this is one of the few programs where neurologists rotate through psychiatry during PGY1 - our inpatient service is also run entirely by PGY1s and attendings (no other residents involved), so that creates a lot of camaraderie between neuro and psych, since all of the psych interns work directly with all of the neuro interns.
7. Unique opportunity to get a T32 grant as an attending rather than as a fellow, which means that you'd get the grant support that would otherwise require you to be a research fellow, but you'll get attending-level reimbursement for your clinical work (up to 20%) rather than just being required to do clinical work and getting paid as a fellow.
8. Solid clinical training with a very flexible option for how much research you want to do (rather than having a dedicated research track that ties you down to a specific amount of research while compromising clinical training).

Probably also several other things I'm not thinking of right now. Get in touch with me if you can and I'm pretty sure I can convince you that this program is perfect for you.