Getting Into A Competitive Residency

[bjackrian]

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It's really hard to use the applicants per spot number to make comparisons because there's a good amount of self selection. If I passed everything and had a 200 step one, I'm not very likely to apply for derm (or whatever competitive specialty you want to fill in the blank with), and that'll skew the stats.

Additionally, my understanding is that the applicants/slots statistics are based on each individual's ranking list's first choice (e.g., if a person ranks ENT first and gen surg second, they're viewed as an ENT applicant). This has two effects. First it skews the gen surg stats down (in my example) because people who apply for ENT (or other more competitive specialties) are likely to be more competitive applicants, and they are not included in the gen surg pool. Secondly, people are not going to rank programs where they don't interview, which means that there are probably considerably more applicants for competitive specialties than the statistics represent.

Variations on these theories also apply to Step I averages and other measures. Bottom line: it's really hard to use statistics to quantify how hard it is to get into a residency program.

 

[NCF145]

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

Where can I get a new copy of Iserson's? I have looked on Amazon and BN, but neither of them have new copies. Do medical school bookstores have it?

 

[Anka]

Med school bookstores usually have it; you can probably get a copy from your school library or upperclassmen. Why not just buy it used from Amazon? It's not the kind of book you really need to get a new copy of.

Anka

 

[Winged Scapula]

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).

I guess if you use Step 1 median score as the definition of competitive, then general surgery is obviously less so than many other specialties.

However, the data you provide are two years old, the year in which applications really shot up, and the "quality" of applicants (as defined by test scores) hadn't really caught up. The number of applicants per position is much more than internal medicine, so I tend to define competitive as a specialty in which in may be hard to get a position - either because the number of positions is less than the number of applicants and/or you have to have higher numbers to get one of those positions (which is really true for things like Derm).

 

[Critical Mass]

I guess if you use Step 1 median score as the definition of competitive, then general surgery is obviously less so than many other specialties.

However, the data you provide are two years old, the year in which applications really shot up, and the "quality" of applicants (as defined by test scores) hadn't really caught up. The number of applicants per position is much more than internal medicine, so I tend to define competitive as a specialty in which in may be hard to get a position - either because the number of positions is less than the number of applicants and/or you have to have higher numbers to get one of those positions (which is really true for things like Derm).

😎 Much respeck. {Kimberli Cox}

 

[Winged Scapula]

😎 Much respeck. {Kimberli Cox}

Eh, not needed...just here to keep rumors and half-truths down to a minimum! 😉

 

[deleted77919]

Where can I get a new copy of Iserson's? I have looked on Amazon and BN, but neither of them have new copies. Do medical school bookstores have it?

You can order it direct from the publisher, Galen Press.

http://galenpress.com/025.html

 

[Bertelman]

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.

And I know a student that just matched Ophtho despite having to repeat an MS1 class, after failing both the class AND the remediation. MD = 5 years.

 

[Samoa]

It's really hard to use the applicants per spot number to make comparisons because there's a good amount of self selection. If I passed everything and had a 200 step one, I'm not very likely to apply for derm (or whatever competitive specialty you want to fill in the blank with), and that'll skew the stats.

But if there are still more applicants than spots despite such self-selection, that's an even stronger argument that that specialty is competitive.

 

[AggieJohn]

Where can I get a new copy of Iserson's? I have looked on Amazon and BN, but neither of them have new copies. Do medical school bookstores have it?

I bought Iserson's 7th Ed. from Amazon.

 

[bjackrian]

But if there are still more applicants than spots despite such self-selection, that's an even stronger argument that that specialty is competitive.

Fair enough. I just think there are too many confounding variable to make the comparisons that simple.

 

[Samoa]

Competitiveness is entirely about the number of applicants vs. spots. Prevalence of high board scores, research and AOA among applicants are all effects of this, not causes. Lifestyle, reimbursement and fit affect competitiveness only because they are determinants of the number of applicants.

Self-selection on the basis of perceived competitiveness is simply a feedback loop, with positive and negative effects affecting whatever trend is already in progress. The net effect is probably negative feedback, bring more people into less competitive specialties and discouraging people from pursuing more competitive ones.

 

[reallyanon]

I think that the other thing that many people don't realize that haven't gone through the residency application process is that there are more and less competitive fields in medicine but there is more overlap than you would be led to believe on SDN. If you were to draw plot out a distribution with "difficulty" of getting a spot on one axis and # of programs at this "difficulty" level on another I think that what you would find is that different fields will have tremendous difference in the variance of their curves. That is to say that fields like derm or rad onc will have a very narrow curve with an average to the right of this plot while fields like internal medicine will have a tremendousy broad curve with places like BWH/MGH/UCSF at one end and unfilled malignant community programs at the other. But the truth is that the curves of these fields especially at the high end would overlap far more then you might think just reading SDN. My personal experience with this was double applying in radiology and medicine. I did this not because medicine was a backup but rather because I couldn't decide. I got a bunch of ranked to match letters/calls from HIGH end radiology programs and got no love from a couple of the medicine programs. Everyone here would agree that radiology is a "more" competitive field than medicine but getting a medicine spot at MGH can be just as challenging as getting a radiology spot at a top radiology program. I hope that people know that if you want to go to a high end program regardless of how competitive the field you will have to work hard and do well. Similarly don't write off a field simply because people on SDN have higher board scores or grades than you. There will always be scrubs that end up in derm and #1 people in the class who go into family practice because ultimately you may find that doing a competitive field will not make YOU a happier person or a better doc.

 

[MedicineForLife 777]

I'm an MS I so I'm still pretty new to everything right now, especially to how residency works. What do we need to get into a competitive residency? How much do grades matter? STEP scores? Extracurriculars? Recommendation letters? Etc? And how do all these aspects rank in terms of importance in relation to each other?

Just wanna start off on the right foot! Any help is appreciated! 😀

 

[lord_jeebus]

Matter a lot:

3rd year grades/evals
Step I
Dean's Letter "adjective" / class rank
AOA status
Interview
In very competitive fields, letters from influential people

Matter quite a bit:

Letters of rec
Research (depends on field, extremely important for some like RadOnc)
Step IICK, if you choose to take it early

Not so important:

Preclinical grades
Extracurriculars

I'm probably missing a few things.

 

[MedicineForLife 777]

Thanks for replying lord_jeebus! How are the Dean's letters composed?...especially since we don't all personally have contact with the dean?

Also, how is AOA status established?

 

[lord_jeebus]

Thanks for replying lord_jeebus! How are the Dean's letters composed?...especially since we don't all personally have contact with the dean?

Also, how is AOA status established?

The Dean's Letter (aka MSPE) is basically a summary of the evaluations you get over your medical school career, with emphasis on clinical rotations. Most will also include an "adjective" at the end that implies your standing in the class, if class rank is not stated outright.

AOA criteria are determined internally, but grades are always the main criterion. Some schools may use Step I. At some places, the process is rather political.

 

[DadofDr2B]

There is a thread called "General Residency Issues" or you can search for a poster named "aProgDirector" who actually is a program director.

 

[MedicineForLife 777]

Matter a lot:

3rd year grades/evals
Step I
Dean's Letter "adjective" / class rank
AOA status
Interview
In very competitive fields, letters from influential people

Matter quite a bit:

Letters of rec
Research (depends on field, extremely important for some like RadOnc)
Step IICK, if you choose to take it early

Not so important:

Preclinical grades
Extracurriculars

I'm probably missing a few things.

I was reading a First Aid guide to residency last night, and this is how they ranked "academic factors important to residency directors":

1. grades in specialty clerkship
2. grades in specialty elective
3. other clerkship grades
4. class rank
5. USMLE STEP 2 scores
6. AOA
7. elective grades
8. USMLE STEP 1 scores
9. preclinical grades
10. research activities

I thought STEP 1 was more important than STEP 2. I wonder how accurate this is...well...it is from a First Aid book!

 

[notdeadyet]

AOA criteria are determined internally, but grades are always the main criterion. Some schools may use Step I. At some places, the process is rather political.

There is some politics, but I believe that schools are required to choose from the top 20% of ranked students, so they can't just choose Charlie because he's such a swell guy. Jut about any med school you go to, if you're in the top 20% academically, you're pretty damn sharp.

And for most true pass/fail schools, AOA is mostly determined by 3rd year clerkship rankings and Step 1.

 

[shreypete]

I heard that if international students want to apply to American residency programs, they don't really look at school grades per se as there's no precise way of equating the scores? Is this true? If so, I would assume that they look more into the MLE scores and other aspects (like electives in US, rotations, observerships and so on)?

 

[yaah]

You asked this question last year, so I merged this current thread with the last one. I don't think the advice has really changed.

 

[Kraft7]

My thoughts regarding First Aid to residency guide: This source seems pretty sketchy!

I don't think there is any way that Step 2 is more important as Step 1. I would say that the minority of students have even taken Step 2 at the time applications are submitted (September). Those who have taken Step 2 by this time either did poorly on Step 1 and would like to show improvement or their school has a crazy-early deadline (Most that have deadlines have those in December).

About elective clerkship grades - we all know these vary a lot. Many schools are Pass/Fail or Credit/No-Credit with respect to electives. I would say that in a given specialty, your letters of rec by attendings in that specialty mean more than your clerkship grades. At some school 5% honor, at others that number can be 75%!

 

[taurus70]

It's really hard to use the applicants per spot number to make comparisons because there's a good amount of self selection. If I passed everything and had a 200 step one, I'm not very likely to apply for derm (or whatever competitive specialty you want to fill in the blank with), and that'll skew the stats.

Additionally, my understanding is that the applicants/slots statistics are based on each individual's ranking list's first choice (e.g., if a person ranks ENT first and gen surg second, they're viewed as an ENT applicant). This has two effects. First it skews the gen surg stats down (in my example) because people who apply for ENT (or other more competitive specialties) are likely to be more competitive applicants, and they are not included in the gen surg pool. Secondly, people are not going to rank programs where they don't interview, which means that there are probably considerably more applicants for competitive specialties than the statistics represent.

Variations on these theories also apply to Step I averages and other measures. Bottom line: it's really hard to use statistics to quantify how hard it is to get into a residency program.

You also have to write a personal statement geared towards your #1 choice. Its hard to write a ps if you are applying to dermatology and radiology for ex. There's not a lot of common ground between the two fields. It either looks too generic or one has to suffer at the expense of the other.

 

[Blesbok]

Everyone seems to be ignoring the most important part. Make as many friends as possible. Step 1 is most important, personality is second, everything else is just icing.

 

[Ashers]

You also have to write a personal statement geared towards your #1 choice. Its hard to write a ps if you are applying to dermatology and radiology for ex. There's not a lot of common ground between the two fields. It either looks too generic or one has to suffer at the expense of the other.

I'm not looking forward to writing a personal statement. It was painful for med school; it's going to be more painful for residency.

 

[roja]

I am not sure about other fields, but in mine, the PS is the *least* important part of an application.


Make sure it doesn't have any typo and has good grammer. Outside of that, I wouldn't worry about it.

 

[Blade28]

Make sure it doesn't have any typo and has good grammer. Outside of that, I wouldn't worry about it.

It helps if you have good grammar as well, not just:

😉

 

[Ashers]

Because of him ^, I always have to look up how to spell "grammar."

 

[roja]

Well, I have to confess, I am working in the ED right now (not to busy, only about 24 active patients in the ED) and multitasking. Add to it, the main reason I went into medicine was to cover up my horrid spelling (I thought it was to get the dudes, but turns out this was a bad plan). (thank god for spell check. see, spell check your PS. )

 

[drfunktacular]

I am not sure about other fields, but in mine, the PS is the *least* important part of an application.


Make sure it doesn't have any typo and has good grammer. Outside of that, I wouldn't worry about it.

We had a residency application workshop where the medicine chief residents told us that the only people whose PS stands out are the ones who stand out negatively and make it clear the the author is a sociopath/weirdo/otherwise undesirable. Otherwise they don't pay much attention at all.

 

[Ashers]

I've had so many ortho residents tell me to write a good, short PS because it's important. Then a CT surgeon who's writing a letter for me gave hints like not to make it sound too dramatic, or weird, and they like to use the PS since that's what makes med students less generic.

 

[bodonid]

Given that

1) Most students do research these days
2) Our best chance (time-wise) is 1st year
3) We are best served by doing research in our eventual career area

How do people reconcile these things if most people change their intended concentration before all is said and done?

 

[kdburton]

Agreed. I've heard from several residency directors that extracurriculars don't matter.

The residency director for orthopaedics at my school told me Step 1, Step 1, Step 1, maybe some research, and definitely some extacurriculars (but I think he meant more along the lines of hobbies outside of school). He said that if someone didn't like to play a sport, play an instrument, yadda yadda outside of school for 3+ years then they probably had something wrong with them.

 

[Doctor J]

Given that

1) Most students do research these days
2) Our best chance (time-wise) is 1st year
3) We are best served by doing research in our eventual career area

How do people reconcile these things if most people change their intended concentration before all is said and done?

Most students do not do research. A sizable minority do research, but not most.

There are opportunities to tag onto a clinical research project in third year in a specialty you are interested in. Other than that, I can't tell you.

Honestly I think the whole research hoop is a bit silly. I respect research and those who do it, but I see a lot of med students doing research just for the CV bulletpoint, which in my opinion is... silly. I guess it helps your chances of a competitive specialty, but seriously, spending your entire summer between 1st and 2nd year in a lab that you hate? To what end?

 

[IcedTea]

Hi everyone! I just got accepted into medical school, and I'm so excited to start in the fall! 😀

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! 😀 👍

Be on the top of your game for the next four years. Enjoy yourself while in med school, and work hard. I don't need to tell you what you need to excel in to get into a competitive residency because others have already addressed that: class rank, rotations, LoRs, etc.

One more thing though. It's a very competitive world out there. You need to strive to be the best at what you do to attain what you want. There are many people out there that have the same mentality. If you want to get into competitive residencies, you have to perform at a notch above everyone else. Do your best, and don't lose focus.

Good luck👍

And remember, just chillax. Don't be one of those gunner students who have no life and just study 24/7. Learn to balance work and play. I study everyday, but I still have time to hang out with friends, go see movies, play videogames, etc. Med school does not = to no life.

 

[Pinkertinkle]

I guess it helps your chances of a competitive specialty, but seriously, spending your entire summer between 1st and 2nd year in a lab that you hate? To what end?

A summer is a small price to pay if it gives you more options come residency.

 

[RxnMan]

Given that

1) Most students do research these days
2) Our best chance (time-wise) is 1st year
3) We are best served by doing research in our eventual career area

How do people reconcile these things if most people change their intended concentration before all is said and done?

Check the Research Forum FAQ (link in my sig vvv).

 

[guitarologist]

So...when people say, "Research is pretty much mandatory for certain specialties, like RadOnc," does this mean that the research must be related to RadOnc, or that ANY in-depth research will do?

 

[RxnMan]

So...when people say, "Research is pretty much mandatory for certain specialties, like RadOnc," does this mean that the research must be related to RadOnc, or that ANY in-depth research will do?

Read the Research FAQ. All is answered there.

 

[DrZeke]

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).

I agree, at my school we have 2 free clinics for students to work in and we have a ton of health fairs where there are many leadership positions and even if you're not a 'leader' you still get to put this on your resume with a short descriptor. When your descriptor says that you've done a bunch of procedures as an M1 or M2 that some people get to do only on rotations I think that's pretty huge. Students at my school who were on the interview trail this year repeatedly said that they were asked about these department of community service experiences and their international trips. It really does depend on what is available to you at your school, what the position entails and how your present it. 🙂

 

[mikedc813]

So...when people say, "Research is pretty much mandatory for certain specialties, like RadOnc," does this mean that the research must be related to RadOnc, or that ANY in-depth research will do?

To quickly respond, from personal experience research is a MUST for radiation oncology. In general, it is not mandatory that the research be in the field that you are applying for, but it is HIGHLY recommended. Research in your intended field is evidence that you have an interest in that field and that you have spent time learning about it. If you're not sure what you want to go into yet, getting involved in any project will potentially benefit you down the road.