gen surg--will I get in? (med student needs advice)

[kiratki]

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Hi everyone, I'm in need of some advice about a general surgery residency program. Namely...can I get into one?

I'm just finishing my third year at one of the smaller Univ. of CA med schools, I got a 224 on Step I, and honors in two of my third-year clerkships. I did NOT get an honors in Surgery. I am NOT AOA. I have great letters in all my rotations. The only bad comments I've had were on medicine "could follow up on lab results more" and one on surgery "some faculty found her sarcasm inappropriate at times" (I am not a sarcastic person...this is from the one not-so-nice attending in that subspecialty). On two of my third-year rotations, they said the only reason I did not get honors was my shelf exam score (I tend to do in the 70th percentiles) Basically the main problem was my "average to above average fund of knowledge". Translation: not outstanding enough for honors in surgery. Does this mean I am too dumb to get into a good residency? I am thinking about eventually doing either trauma or surg oncology, so I need to get in somewhere where a fellowship isn't ruled out.

I think my main strengths are that I work really, really hard, and that I have a good attitude and get along with most people. But they're right I don't have a great fund of knowledge. I think this is something I can develop over time, and I'm going to work hard for my sub-internships.

By the way, I'm female.

So after hearing that long story, I have some questions:
1. Am I going to get into a general surgery residency? I saw another posting about top vs middle vs low tier programs. What tier should I concentrate on?
2. In terms of other background, I did my undergrad at Harvard and went to Johns Hopkins for public health school. I have one publication in an obscure social network analysis journal where I am third author. Should I draw attention to this information in my ERAS essay or somewhere else?
3. What can I do to make up for not getting honors in surgery (or being AOA)? My first two years weren't any better in terms of grades.
4. Any general advice besides, "grow a second brain before your away rotations"?
5. I'm applying almost everywhere in CA, New York City, and Chicago. Also Oregon, Tulane, and Emory. Any other suggestions?

Sorry for the long drawn out email, I just got my surgery grades so I don't know how to fix this.

Thanks for any help you can give me. I'll try not to pester this forum too much.

Sincerely
Kira T. Ki

 

[ArrogantSurgeon]

Fear not, from all the advice I have heard you will most likely get into an academic program and definetly into a community program if you want.

Your Step I score is definetly good enough for most surgical programs (academic and community).

You will graduate from a UC, and if you have checked the match list from ANY of those schools you'll realize that they get great residencies. Not too mention you went to an awesome undergrad (the "H" bomb factor) and and Hopkins for public health...PDs will notice and like this.

And you said you work very, very hard...which is something PDs love to see, sometimes more so than a higher USMLE score.

Putting all this together I'd say you have an extremely good chance at matching into an academic program if you want since your thinking about fellowships in the future.

I'm sure others here will give you some more good advice. Good luck😎

 

[tussy]

Don't fret. The most important thing that will get you into a residency is working hard, desire to be there and getting along with others. Nobody expects medical students to have a "great fund of knowledge". A few tricks you can use to make yourself look smart are:

- read around the diseases that the patients on the floor have
- get the OR list the day before and read about the disease, anatomy etc. Most likely they will ask you questions during the case that pertain to the case, and it will show if you are prepared. A book like surgical recall is good for this.
- if your attending asks you a question about a topic and you don't know the answer then look it up that night. Most attendings only have a repetoire of a few questions that they routinely ask clerks, and they may forget the next week that they already asked the question and ask again! It's like having a copy of the previous years exam!
- Carry a small pocketbook in your labcoat pocket that you can refer to if you encounter a patient with a problem you know nothing about. REad about the problem before you present the patient to your resident/attending



General surgery is a lot of fun, and right now it's not overly competative. If you're willing to work hard and be enthusiastic you'll have no problem getting into a program. Good luck!

 

[md03]

You are a competitive candidate. My school uses letter grades and my only non A in the clinicals was a B in surgery. During the entire interview process, not one person ever commented on it. There were a few comments about my board scores (I did do very well, add about 20 points to your very respectable score). I did not make AOA but still managed to land an interview at MGH (had a letter from one of their grads which I think helped).

I matched at a very strong program.

I'd suggest you make a tentative list of about 25 programs and then set up a meeting with the program director at your school. Take your transcript and board scores and get some input on how realistic your list is. Then when you apply, why not apply to some "long shot" programs as well as some "safety" programs, with the bulk of your applications going to programs on par with your credentials.

The ACS web site has a link for the "so you want to be a surgeon" book (well, it used to be a book, anyway). In there is section on choosing programs that has some information on programs. Many of them indicate the percentage of their residents that are AOA (it will say either >50%, 25-50%, or <25%)
That was the only thing I was able to find that gave you a rough idea of how my grades would stack up for that progam.

You also have time to get some good LOR, which I found was the biggest factor in the whole process.

I totally understand the moments of stress that lead you to think you won't match. Calm down. You WILL match and you will be happy with your match. (Unless you do something risky like not rakning enough programs or rank a program you know you won't be happy at.)

Good luck and enjoy your 4th year surgery electives!

 

[Skylizard]

Originally posted by kiratki
...one of the smaller Univ. of CA med schools, I got a 224 on Step I, and honors in two of my third-year clerkships. I did NOT get an honors in Surgery. I am NOT AOA. I have great letters in all my rotations...

Should be enough. AOA is not required or necessary.

Originally posted by kiratki
...The only bad comments I've had were on medicine "could follow up on lab results more" and one on surgery "some faculty found her sarcasm inappropriate at times" (I am not a sarcastic person...this is from the one not-so-nice attending in that subspecialty)...

Often, these comments are edited from your final transcript.

Originally posted by kiratki
...Basically the main problem was my "average to above average fund of knowledge". Translation: not outstanding enough for honors in surgery. Does this mean I am too dumb to get into a good residency?...

To answer your question, NO. This is NOT aproblem.

Originally posted by kiratki
...I think my main strengths are that I work really, really hard, and that I have a good attitude and get along with most people. But they're right I don't have a great fund of knowledge. I think this is something I can develop over time, and I'm going to work hard for my sub-internships.?...

The strengths are fine. I think the weakness is you saying, "they're right I don't have a great fund of knowledge". I advise you not to repeat this statement as that is not what they said according to your post ("average to above average fund of knowledge"). Your fund of knowledge is fine and your board scores support it. Honors are not necessary to get into a good Gsurge academic program.

Originally posted by kiratki
...By the way, I'm female...

From my perspective, this is irrelevant to you obtaining excellent traing.

Originally posted by kiratki
...1. Am I going to get into a general surgery residency? I saw another posting about top vs middle vs low tier programs. What tier should I concentrate on?
2. In terms of other background, I did my undergrad at Harvard and went to Johns Hopkins for public health school. I have one publication in an obscure social network analysis journal where I am third author. Should I draw attention to this information in my ERAS essay or somewhere else?
3. What can I do to make up for not getting honors in surgery (or being AOA)? My first two years weren't any better in terms of grades.
4. Any general advice besides, "grow a second brain before your away rotations"?
5. I'm applying almost everywhere in CA, New York City, and Chicago. Also Oregon, Tulane, and Emory. Any other suggestions?...

1. You should have no difficulty getting a nice Gsurgery spot. You should get a faculty advisor and talk to them about your strategy.
2. Read and understand your publication and list it. It is a publication and it shows an understanding of research. Many of us have no publications.
3. You do not have to "make up" for not getting AOA or honors. Your application in general based on how you have presented it is solid. Your education background is solid and your board scores are solid. Have some confidence and do not apologize for your application. Address questions at interviews and if there is a perceived deficiency explain it honestly but do have some confidence. Be carefull as to when you choose to take Step II. It is always a strategy and it likely can hurt you if you bomb it.
4. Just read and study and have a good time. If you try to do an "interview away rotation" know that this can also hurt as well as help and is not necessary in most programs.
5. Faculty advisor that knows you and has your application in front of you can help you in your application strategy.

relax, be confident, have fun

 

[Flatus?]

kiratki you have a PM. For discussion sake I'll post an edited version.

I?d say you could apply anywhere. I?d expect that you will get interviews at some of the top programs but will also not get offers from others-some are just very particular about AOA, board scores, and what med school you come from.

Being female will give you an advantage but this is becoming less so each year.

Based upon the people I?ve seen on the interview trail, I?m going to read into you line of thinking a bit (purely speculation because I don?t know you)-Went to Harvard and went to Hopkins = must go to a big name school. It is always like this. I rarely see a Harvard/Hopkins/UCLA/UC Berkley ect student decide to look at programs close to home or stay where they are so they don?t have to relocate their family. It?s what drove them to get into these great institutions but can also be the root of a very poor life decision.

I like to give all the 3rd years what I call my rules for applying to surgery programs.

1. Academic or community: decide now. Some programs only train one or the other. Most give you that decision to make on your own but why do the extra work at an academic medical center and sacrifice better technical training and OR time but passing up the good (I?d say some are great) community programs? Think about it this way-the majority of residents trained at academic medical centers who do two years of basic science research, will end up in private practice (minus two years of salary).-No I do not have data to back this up, I just heard it from several chairman and PDs on the interview trail.

2. Make your decision on where to go based on three things:
1) Will this program get me to my ultimate career aspiration: see above, also if you want to do a fellowship in a very competitive specialty with limited spots (i.e. Peds surg) you may want to go to a big name place. BUT this is becoming less and less important as the relative competitiveness of all the surgical fellowships continues to decrease. Also-do not make a decision on what fellowship you want to do today. The interest in Peds surg has greatly decreased. Look at what has happened to CT surg in the last three years. You can?t predict what will be competitive and what will not.

Also, evaluate how supportive the program is of there residents. Do they help them land the positions they want? Are the residents getting the positions they want?

2) Can you live in this city and work at this hospital for the next 5-7 (or 8+ if you decide to go to UMinnesota) years. San Francisco and Boston are fun to live in but after you?ve maxed out your economic hardship deferment after 3 years and are taking out more loans just to cover your rent, you might be kicking yourself. Also-if you like the big city, don?t go to a place like the Mayo Clinic in Rochester MN.

3) Can you work with these residents (major) and these attendings (a little less important) for the next 5-7 years. A**holes can make your life unbearable and make you one of them. If you don?t click with the residents when you meet them or quite frankly think that they are incompetent/dorks (relative opinion)/just get a bad feeling from them-move on.

The biggest mistake people make is that they favor one of the above over the other two. Most often they go with the big name and are miserable.

3. Location and the school?s (undergrad/med) general reputation often dictates the competitiveness of a program. Any program in California is very competitive. The Florida programs are becoming more competitive. Midwestern programs have had problems filling in the past. Also-UCLA is probably one of the most competitive programs but I would probably rank 30+ programs ahead of them. (NIH funding is not the be all end all). Also-what had a good reputation in the past doesn?t necessarity mean it has a good one today (i.e. U Chicago) and some programs can greatly improve in a short time (Pitt). Opinions, opinions, let the screaming begin.

4. Getting an interview and a position can often be unpredictable. Offers for an interview are often made by one or a few people. The same can be said for whom they take. There might be something in you application they absolutely love and want you for that reason and for some unknown reason they might dislike you. So apply to the programs you want to go to regardless of how competitive you think you are because you never know what might happen.

5. Get someone with a big name to write you a letter and at the end of the interview process, have them make a phone call to the program you want to go to. If these guys are willing to put their reputation behind you, the program director at the other end will feel more comfortable taking you into his program.

Other subtle rules: Money is good=new buildings are a good sign as are well paid support staff; Faculty and Resident turnover is a bad sign (i.e. U Chicago).

Everyone loves rankings so I?ll give you mine. My criteria are: 1) excellent clinical/technical training in all fields of general surgery (not just 1 or 2 dominant departments), 2) excellent research opportunities, 3) national reputation/faculty prominence/resident support. So this isn?t a rank list that applies to every one. Also I will warn you that some of these best programs have some of the most malignant personalities out there.

Disclaimer: These are my opinions. I?m sure the program that you (the reader) are training in is just as good as Hopkins in the 1950?s. No program is perfect and what is the best program for one person (ex: Mass Gen) would not the best for another (ex: Mayo).*
*why the same person would have these programs on the same rank list is beyond me.

West
Top Tier
UCSF
UWashington

(Top of the) Middle Tier
UCLA
Oregon
USC
UCSD
UCDavis
Stanford

Midwest
Top Tier
Washington U
Michigan
Loyola
U Cincinnati

Top of Middle Tier
UWisconsin
Northwestern
Minnesota

South and Texas
Top Tier
UT Southwestern
Baylor-Houston
U Alabama
Vanderbilt
UNC
Duke
Louisville

Top of Middle Tier
UT Houston
*The Florida programs are a mystery to me right now.
U Virginia
Emory

East
Top Tier
U Pitt
Mass General
B and W?s
Hopkins

Middle Top Tier
U Penn
*New York Programs-vary from year to year.
Yale

Don't know enough about many programs to work them into this rank.

Noticeably absent: U Chicago-please see older posting on the matter, I second all negative comments about that program and may the two residents that dropped out in favor of plastics have the best of luck
Mayo-Mayo is Mayo. You have to see it. I recommend that only people who lived in small midwestern towns apply to the programs. Too many California applicants know they won?t rank the program the second they get off the plane. Training is relatively easy (little call) but not necessarily great. Personally I?d love to see a Mayo physician try to function in a county hospital-WHAT DO YOU MEAN I CAN?T GET A CT SCAN PERFORMED AND READ IN LESS THEN 1 HOUR?

 

[ArrogantSurgeon]

Thanks for the extensive input🙂

 

[Flatus?]

I will disagree with U Minn being top tier although I will say from a training perspective it has been one of the better programs in the midwest. My problem with the program is the leadership's openness to change, relative malignancy, a worsening financial situation of the hospital. But I agree, it is a very good program. The loss of the old PD was a significant hit to the program and marked the begining of many of the problems.

Rush-yes, good training, second to Loyola in Chicago. Just lacks in research and reputation although this is improving.

And I did rank Mayo-(14 out of 14)

 

[kiratki]

Thank you everyone for your very useful advice. I think it's the most practical (and reassuring) information I've gotten, much better than the faculty input I've received.

After a call to Mom and reading your messages I have calmed down somewhat. I'm going to do a lot of research before I decide what my top schools are, and decide based on family considerations, a desire for--sorry--non-rural locales, and a university setting.

I'm still digesting what you've all told me but it's been extremely useful and I appreciate it. Hopefully by the time I'm a resident I will be able to play your role for an aspiring, nervous med student.

Thanks,
K

 

[gabbydoggie]

Do you away rotations at the programs you really want to get in to. Kick butt. See if you actually like it once you work there. Your usmle score is fine. AOA isn't necessary. I got interviews at all kinds of kick butt programs and i'm not AOA. About the negative comments on your clerkships, someone might ask you to explain if they ACTUALLY READ your application/letters, etc. 🙂


about the second brain, i wouldn't wish for that--you'd look like a freak. 🙂


apply to a wide range of programs and see what happens. I applied to 26 places and got 26 interviews. is better to apply too many and turn down interviews than not to get any. 🙂

you are on the right track.

hang in there.