Getting Into A Competitive Residency

Discussion in 'Medical Students - MD' started by MedicineForLife 777, Mar 5, 2007.

  1. MedicineForLife 777

    MedicineForLife 777 Senior Member
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    Hi everyone! I just got accepted into medical school, and I'm so excited to start in the fall! :D

    I'm wondering if you guys can enlighten me on how to get into a competitive residency. So far, I know that we have to have a good class rank, high USMLE scores, and research (any suggestions on when to do this?).

    Do you guys have any other advice for me? I would greatly appreciate it! :D :thumbup:
     
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  3. HOLDENc

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    ...and a gunner is born

    [​IMG]
     
  4. sirus_virus

    sirus_virus nonsense poster
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    No she is not. AlisaGirlX, you have it all down. Some people also throw in some sexual favors here and there, but that is totally up to you.
     
  5. naegleria brain

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    haha! hilarious

    chill. the time will come for that. first thing you're going to learn is that medical school is nothing like anything else. use anatomy to get adjusted.

    i suggest starting research in your first year if you are doing well in classes and have adjusted well. you get the most free time your first year; but everyone's still adjusting, that they neglect it. if you are awesome, you can do it. if you're having trouble, get the whole med school groove down, then take the next step
     
  6. Droopy Snoopy

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    Just do yourself a favor and enjoy the moment for 5 minutes. Please? You got accepted to medical school, congratulations!
    ...










    ...can't do it, huh? *sigh* Well, you've pretty much got it there. I say:
    1) Step I
    2) 3rd year rotation evaluations and LORs
    3) class rank, AOA
    4) 4th year away rotations and who you buddy up to
    5) research
    6) ECs
    7) smashing the interview and ps
    8) Step II

    Best time for research is between years 1 and 2, although you'll have opportunities throughout your tenure.
     
  7. Anka

    Anka Senior Member
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    Get a copy of Iserson's Getting Into a Residency: A Guide for Medical Students (I think the current edition is the 7th, but could be wrong). It will orient you to what is important, and what is more/less important to the various specialties. Don't take it as the bible, though... there are some things in that book that are a little suspicious even without any specialized medical school insider knowledge (like the suggestion that a maroon suit is appropriate interview attire). Also approach possible mentors early, because they will clue you in where Iserson leaves you hanging.

    Anka
     
  8. psipsina

    psipsina Senior Member
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    Wait and focus on just doing your best first semester, and see what that gets you. You don't know what you are capable of in medschool or how you are going to react to medschool so this converstation is pointless. For many people just passing takes their best effort. Everyone who gets in was smart as heck in undergrad and yet only the top ten get to be in the top ten, you don't know how you will perform in this new game, you don't even know the rules yet, so stop worrying if you're going to win and start worrying about how to play.
     
  9. Bitsy3221

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    I will second finding good mentors early. In many competitive fields, who you know is almost as important as what you know, so figure out who at your institution is well connected/well known and start cozying up to them. See if they have a lab or do clinical research; try to do elective rotations with that person/people. Ask senior medical students or residents in your institution that are working in your area of interest. You can also try looking at your school's Match List from recent years, and try and contact grads who went elsewhere to pursue residency training and find out what they did/who they worked with. Be aggressive and interested, but not annoying (this can sometimes be a fine line)

    Of course, this is all based on you knowing what you want to do. Until you figure that out, just focus on getting good grades and study hard for Step 1. Don't overextend yourself with extracurricular activities unless your grades can handle it--being the VP of every club on the med school campus is NOT impressive if you have mediocre grades and a crappy Step 1.
     
  10. Hednej

    Hednej ***** Level 60
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    I'm curious to find out what's more important for matching into your residency of choice (if it's pretty competitive), extra curriculars or research?
     
  11. genX

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    Research I would say just b/c it usually lends itself to making solid connections with the faculty in the field you are interested in going into. Which can lead to great LORs
     
  12. naegleria brain

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    extracurriculars?

    learn this early - extracurriculars are meant for your enjoyment
    if youre spending your time enjoying something, whatever.

    "but doesn't this prove that i enjoy the field?"
    well, every applicant is going to be a part of that club. and every applicant better damn sure like the field; thats not the question; theyre checking for whether they have the work ethic/skill/knowledge

    research indicates work ethic; instead of selling tickets to your school's next charity ball, you went to a lab and stained slides, reviewed charts, etc. instead of going out to the "<insert school here>'s weekend beer run!" you learned how to do a TKA and wrote a chapter/techniques guide for it

    and the connections are sweet too. extracurriculars are for your enjoyment. if you're gonna join, enjoy! research is fast-becoming a must, however, for the more competitive fields. and certain radiology fields (rad onc?) it's getting to be extremely necessary
     
  13. Sophie

    Sophie Lead Foot
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    Agreed. I've heard from several residency directors that extracurriculars don't matter.
     
  14. Law2Doc

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    Agreed. At any school most of the 150 matriculants show up with hopes of competitive residencies, and expecting a great class rank. After a test or two, about half of those folks will be trying to figure out how they can get out of the bottom half of the class. Wanting something doesn't make it so -- you need to have the goods too. And you don't know if your goods are any good (compared to your classmates) until you get there. Keep an open mind about residencies -- despite what you read on pre-allo most med students do not end up in the most competitive fields.
     
  15. AmoryBlaine

    AmoryBlaine the last tycoon
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    They are consistently ranked below everything else. Do what you want to do, joining a specialty interest group will not impress anyone at all.
     
  16. mules05

    mules05 Member
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    This is the message I've been getting from my deans as well, with the caveat that LEADERSHIP in extracurriculars can really help your residency app. I don't think they make a big difference in very competitive specialties (ortho, rads, etc) where research is the key, but in less competitive specialties they will give you an edge in getting interviews and matching at the most competitive programs (e.g. Boston Children's or CHOP for peds).

    My only other comment to the OP is that rather than trying to set yourself up for a "competitive specialty," do some research and find out what specialties you like, do some shadowing during first year, and if you find something you like, set up research for the summer between 1st and 2nd year. Don't add more to your plate before you even know how you'll handle med school.
     
  17. Hednej

    Hednej ***** Level 60
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    What if you do research between your 1st and 2nd year in lets say rads and then you find out that you utterly hate that field and after your rotation you fall in love with Neurosurgery. Are you screwed or is your research still applicable? Is the guy you did research with recommendation's now going to be as important?

    It just seems to me that that's mighty early to be deciding what you want to do and then do your research in that field.
     
  18. TheMightyAngus

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    So true. Forget about figuring out what your interests are. It's more rewarding to seize on things that are most wanted in life. To be the best. That's why we all went to med school, isn't it? To be the ubermensch.

    P.S. No one gives a $#it what research you do in between first and second year. This won't impress anyone because you don't have enough time to accomplish much. Who would give you an important project if you're just going to be around for a couple weeks?
     
  19. indo

    indo Feed me a stray cat
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    step 1 is to attend registration/ orientation.
    step 2 is to study for the following 4 years.
     
  20. psipsina

    psipsina Senior Member
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    Yeah, from what I observed in undergrad research I can't imagine getting anything really tangible accomplished in 6-8 weeks during the summer. I'm spending it shadowing in some specialties that have piqued my interest to try to get a better handle on where I might be going and start making some connections, in addition to hanging in the ER cause and getting my hands dirty (cause thats just fun) and spending time with my long lost family since its probably my last chance until fourth year.
     
  21. smq123

    smq123 John William Waterhouse
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    Part of the point of research is not to get a publication under your belt. Part of the point is to show residency and fellowship directors that you had an early and genuine interest in this field. A fellowship director for ID once said that he looks at people's research/extracurriculars to see if they are genuinely interested in ID, or just applying because they didn't know what else to do (or, in the case of FMGs, are looking for a good way to stay in the US for a few more years).
     
  22. Dr. Will

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    This is a very important point and why I don't think EC are "useless." In all my interviews this year, my holding leadership positions in various activities and projects was brought up a lot, and were more of a focus during my interviews than anything else. I'm going into EM by the way, which is getting more and more competitive. I'll admit though, that EM is a field where they want more well rounded applicants than just someone with great grades and high board scores. While EC's are not the major focus, don't underestimate what they can do to help distinguish you from someone else. Be involved...it's a lot more important than you think.
     
  23. Critical Mass

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    Yeah I'm still working on step 2. Residency is a while down the road.

    Summer M1-2 research is often fluff, so at least make it productive research if you are going to do it.

    If you wouldn't see yourself doing an initial residency in a primary care-related field at all before starting med school, then it's sort of my opinion that maybe you aren't going into medicine for the right reason or at least that you aren't open-minded enough. I'm not saying that people who choose competative specialties are doing it for the wrong reason because I understand that people genuinely want to do those things, but coming right and saying that you're interested in a competative specialty especially without specifying one in particular before you even start medical school does sound gunnerish.

    Competition arises from fear of working your butt off without "just" recompense. Fear leads to anger and aggression. Anger, fear, aggression--the dark side are they. Once you start down the dark path, forever it will dominate your destiny.

    Padawans, just do your best! The rest will work itself out. I promise you that they are not going to ask you something on boards that hasn't been covered. Do research if you are interested in the field, not as a means to an end. The rest will work itself out.
     
  24. Anka

    Anka Senior Member
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    A lot of this advice is going to depend on what you want to go into. A mentor (and not just at the faculty level... talk to residents and upper level medical students) can help you figure out what to do at each step to wind up where you want to wind up (or to help you figure out where that is).

    Anka
     
  25. melast

    melast New Member
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    I was wondering what the consensus is on if research done before medical school (several years, several pubs, medically relevant) "counts" towards making you an appealing residency applicant, or if the research must have been done as a medical student..
     
  26. Droopy Snoopy

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    It's just like the med school app process, stuff you did back in high school (if not continued into undergrad) doesn't carry much weight. That's my guess anyway, I'm not exactly a PD or anything.
     
  27. Critical Mass

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    There will be a tendency to compare you to other applicants as far as what you've done during medical school is concerned.

    Any research that you've done will be helpful, especially if you can defend what you published and/or the interviewers are interested in what you've done.

    It can certainly help you, but I wouldn't use it as a license to not do research during med school if you are interested in a particular field.
     
  28. TheMightyAngus

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    After first year, you really shouldn't know what field you're interested in. Even if you think you do, no one really believes you until after you've been exposed to it during third/fourth year.

    Doing some crappy project over eight weeks isn't a good way to gain exposure to any field of medicine. Most research projects require hours reviewing charts, dismembering laboratory animals, calling patients on the phone, or inputing data from questionnaires. None of this relates to what a derm/ortho/radonc/rad/ophthalmologist does.

    Do you really think fellowship directors care how you spend your summer after first year? Not one iota. Fellowship is an entirely different beast that should not be seriously considered by any med student. Talk about gunner.
     
  29. 54578

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    Hahahaa Brilliant! :laugh:

     
  30. Kfire326

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    zomgwth? You just got into med school...be happy. Don't you want to stop thinking for a while?
     
  31. Bitsy3221

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    I applied only to academic surgery programs, so that is the only area I have experience with. The previous poster who is going into ER who talked about his EC a lot during interviews had a different experience, so there are obviously different takes on this. Honestly, this whole discussion is strongly based on both the specialty and type of program (academic vs. community) so it can be hard to take anything meaningful away from this thread without knowing this.

    I actually did quite a bit of EC participation in med school, but the only thing I was ever asked about was post-Katrina clinic work. The on-campus stuff never came up. A personal friend who is an attending on a residency review committee told me that they only ever really consider EC if the student was in a leadership position on a national level. Doing the stuff on campus, or even being a class officer may not hold as much weight as it did in HS or undergrad. As someone said already, do it b/c you enjoy it not b/c you think it will help significantly for residency. In terms of free time, research beats EC, hands down

    Again, my experience is with academic surgery, so take that for what it is worth.
     
  32. smq123

    smq123 John William Waterhouse
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    I'm not a gunner, but, as I near the end of MS2, it's time to start thinking about what I want to do. The electives that I will have to choose for 3rd and 4th year might make a difference in which residency program I get into. I'm already thinking about residency and fellowships - ID sounds like a lot of fun, but different programs focus on different aspects of ID. Which program do I want? Which residency will give me the best Int. Med training before I subspecialize? etc.

    As an MS1, how do you know that what you do the summer after first year won't matter? (For the record, I spent my last summer at home, doing basically nothing.) How many fellowship directors have you actually talked to?

    Besides, did you stop and consider that the research experience that you garner during that summer after MS1 might help you put together a better research project later, as an intern/resident? And that that might help you get the fellowship you want? Looking at the big picture and realistically worrying about your future doesn't mean that you're a gunner.

    However, if you're a pre-med and about to start, don't worry about it now. You can worry about it later.
     
  33. Bitsy3221

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    Fellowship is so far in the future, and you are going to become such a different person and physician between now and then. I am not a fellowship director, but I have worked with some and have had many friends go through the fellowship application process, and I am confident saying that 99% of the time, that M1-2 summer (or really, much of med school) doesn't make much of a difference. Unless (like you said) you get hooked into a big time research project, it will likely never come up.

    Fellowship directors want good physicians--they care about the LOR from your residency attendings and your scores during residency (ABSITE, etc.) There are always examples of mediocre med students who developed into top-notch residents, and fantastic med students who were average (to below average) residents. Fellowships are likely to take the top residents, not the gunner med students. Think about it--how many of you were grilled about what you did between freshman and sophomore year of high school when you interviewed for med school??
     
  34. dilated

    dilated Fought Law; Law Won
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    Research is vital for selective fields. Research in the field you want in particular is even better.

    Explore different specialties. You should be able to come up with a few that you enjoy doing and think you might want. Those are the ones to do research in. Myself, there are a couple things I might like. One is EM. But EM is definitely the easiest of the things I like to match into, so doing EM research would be kind of a waste (plus EM research is often harder to get than other stuff), so I'm not doing EM research.
     
  35. smq123

    smq123 John William Waterhouse
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    True, fellowships want good residents, but some also want good researchers. Research in the summer after MS1, especially if you've never done serious lab research before, might help you put together a better research project when you're a resident. My sister got her pulm fellowship (she's now a pulm attending) because her research project as a resident was so good.

    Like I said, for some competitive fellowships, showing an early interest can help. If any took the time to read what I wrote earlier, I never said that you HAD to do research after MS1 in order to get a good fellowship. I didn't do anything useful last summer, and, while I hope that this doesn't come back to bite me in the a$$, I doubt that it will make any difference. Just don't knock those who do decide to do a research project (no matter how trivial you might think it is.)

    That being said, one of my friends who would like to do ortho had a "discussion" with one of the deans, and is now trying to figure out where to do a research project sometime in the next 2 years.
     
  36. MedicineForLife 777

    MedicineForLife 777 Senior Member
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    Thanks for all your replies everyone! It truely helped a lot! :D

    Just for the record, I'm not a gunner (at least not a hostile one). I just want to prepare for my future and make sure that I'm doing everything that I can be doing to succeed. I always try to plan ahead. Also, I know that you guys think I'm crazy for thinking about residency when I just got accepted to med school, but when I say "just" I mean a few months ago. :laugh: So I had some down time to enjoy it.

    And some of you are curious about the specialty I'm considering. So far, I've considered cardiology, cardiothoracic surgery, or general surgery (maybe even ER). I'm actually a nurse right now so I've been exposed to pretty much every specialty, and these are the ones that really piqued my interest. Thus, I'm not considering a competitive specialty for the wrong reasons. They just happen to be competitive....

    Anyway, I really do appreciate all your help! Keep that advice comin! :D :thumbup:
     
  37. Critical Mass

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    Careful, people get cranky when you call Emergency Medicine ER around here.

    BTW general surgery isn't that competative anymore, and CT is easy to get into. Cards? IM first, also not competative until you get to the fun PGY stuff.
     
  38. MedicineForLife 777

    MedicineForLife 777 Senior Member
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    haha really? Why is that?

    Also, what's PGY? And is cardiothoracics truely easy to get into???
     
  39. Critical Mass

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    Pride I guess. ER is a location, EM is a specialty. So it goes...

    ORL's don't like being called ENT's either.

    PGY = post graduate year(s), residency. Cards is competative, but the IM residency that you do first is not. Anyone who completes a general surgery residency (again, no longer competative) can do CT. Last time I posted on one of these threads, people spoke of unmatched CT fellowships by the masses. Invasive cards has decreased the demand for CT surgeons, so it's not competative.
     
  40. Dakota

    Dakota Senior Member
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    And it's not even called the ER. It is the ED. Calling it a room is a throw back to times before the emergency of modern emergency medicine.

    Not trying to sound harsh, trying to give advice that will help you get along with the crankiest of Emergency Physicians (admittedly I haven't met many, the EM personality is usually laid back . . . people who get wound up tend not to like the fast pace and stress).
     
  41. Critical Mass

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    :eek: So true! I meant to type "television show" rather than "location." My TV is showing an infomercial for "Girls Gone Wild," and I was distracted. :(

    OP--I edited above to answer your other question. Didn't know if you saw that or not.
     
  42. Samoa

    Physician Pharmacist 10+ Year Member

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    People will ask about anything unusual in your application. I applied in a very competitive field (i.e. one in which most applicants have research experience, if not multiple pubs). I did get more interview invitations because of my leadership experience, but there was no interest in it beyond that point. However, I was also a member of a club with a very unusual name and purpose, and I got asked about it at least once at every place I interviewed.

    So your EC's will only help you if your application is already solid. As with the med school application process, it won't make up for any deficiencies.
     
  43. Law2Doc

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    Agreed. This list was not what comes to mind when the OP used the word competitive.
     
  44. AmoryBlaine

    AmoryBlaine the last tycoon
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    I don't think it is bad or gunnerish to be thinking about the long-term even as an M1. On the flip-side of the coin are those med students who are behind the eight-ball from the beginning. They have only a dim idea about Step1, don't really understand what it means to be an M3, cannot describe the process of the Match, and don't have any idea which fields are relatively more competitive.

    It's not the end of the world and most of them will get along just fine, but I hardly think it's ideal. Iserson's is a pretty good place to start.
     
  45. Winged Scapula

    Winged Scapula Cougariffic!
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    Not sure where you got the idea that general surgery is no longer competitive - that was true 5 years ago, but the competitiveness and the number of US grads umatched in general surgery has increased significantly over the last 2 years.

    It is true that CT surgery is no longer nearly as competitive as it once was, and although the number of apps increased last year (from an all time low of 3 positions per applicant the year before), there will be an increased need as current surgeons retire...some things (ie, valves, congenital anomalies and transplants) will not be taken over by cardiologists.
     
  46. Hednej

    Hednej ***** Level 60
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    I really appreciate everyone's input and I'm sure all other incoming med students do as well. I just want to emphasize that I'm not planning on going into a competitive residency just because it's competitive or the lifestyle is great or etc. I just wanted to learn more about the whole process so I could have more options when the time comes to decide on a specialty. More advice will be greatly appreciated.
     
  47. LJDHC05

    LJDHC05 Former Chicken Slayer
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    I think the best advice is to just do your best once you're in.

    You're not going to magically get into an ORL program trying offset a craptastically average Step 1 score and a mediocre class rank with EC leadership and research. All else equal, you're going to be offered interviews based upon your Boards, class rank, Dean's letter, your away rotation at the place (if you did one) and then research/ec's compared to the applicant pool. Then after your interview, you'll be compared to everyone else that interviewed and ranked by the program.

    No one component in your med school career is going to set you so far above everyone else in a competitive field that you'll instantly be accepted. It is the consistent strong performance over the first 3 years that will get you into whatever residency you want to do.

    OP take the next few months to relax, because once you've started your life will never be the same again.
     
  48. Critical Mass

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    Where did I get the idea? Well I know a student who matched general surgery whose grades were so bad that she nearly had to repeat a year of med school.

    I also looked at this thing:

    http://www.nrmp.org/matchoutcomes.pdf

    and saw that the median step 1 score for general surgery among US seniors was about the same as internal medicine (figure 4).
     
  49. smq123

    smq123 John William Waterhouse
    Administrator Physician SDN Advisor 10+ Year Member

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    I believe that you're focusing in on the wrong numbers. If you look at internal medicine, there were .65 applicants per position. There were nearly 2000 more available slots then there were applicants. However, if you look at gen surg, there were ~ 1.5 applicants per position, and roughly 500 more applicants than available positions. Based on these stats, I'd agree with Kimberli Cox.
     
  50. Critical Mass

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    That's a tough stat. Derm is listed as 1.16 (similar to ortho) and has a step 1 mean of 233, and I don't think that many people would believe that general surgery (step 1 mean 222) is more competative than dermatology. Rad onc 1.09 (step 1 mean 228). My point is that there may be 1,000 people who want to do derm, but only the best 366 will even bother to try. What I don't know is whether or not the 1522 surgery applicants include people who applied for both general and a specific surgical specialty. If somebody matched outside of NRMP, would they be part of the 1522 even though they're no longer participating in the match? If so, they actual 1.45 should be lower.

    I have had a hard time communicating on SDN when people use terms like "competative" and/or "harder" because I believe them to be Loki's wagers. In my view, having a higher expected step 1 score makes something tougher to match.

    I drew a comparison to internal med because it was close to surgery on the chart (220 vs. 222). I however posit that the strongest PGY applicants interested in surgery will be more likely to opt for surgical specialties that offer higher pay (e.g. ortho, plastics), improved patient satisfaction (ophtho), or more opportunity to manage disease medically as well as surgically (urology, ORL) than general surgery which is mired with the view that the lifestyle is horrible.
     
  51. alwaysaangel

    5+ Year Member

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    That really depends on your def. of extracurriculars. I currently work in free clinics and will continue in to work in free clinics in medical school - I doubt that would be shot down as something someone is doing "soley for enjoyment" which residency directors would ignore. If someone had a job in medical school - again I would call it an EC, but its surely not going to be shot down as somethign the applicant did for "fun"

    But anyway - is research to get into residency kind of like research to get into medical school? A nice touch but far from required? (I know it depends on the specialty - but in general).
     

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