How do pathology residencies weigh clinical years grades?

[mm3781]

I was wondering how heavily grades from the clinical years are weighed in to consideration for pathology residencies. I know I want to do pathology, I love the work, and I have a real talent (or at least I think I do) when it comes to pathology. It just seems to be the one area of medicine that came easy to me and I enjoy learning more about. The problem lies in years 3 and 4 of med school. I abhore certain things such as ob/gyn and psychiatry, and while I am not going to totally slack off on them, it is going to be hard for me to develop any interest in these rotations. So, I guess I am wondering if a top program (like the top 2 or 3) will count someone out if they only get a "pass" in a few rotations (versus high pass or honors), weighing in that I was top of my class the first 2 years, I have a borderline astronomical Step1 score (I am not trying to sound like an ass here at all, just trying to present the entire picture truthfully), and I plan on doing 2 away pathology rotations and working my a$$ off during those. Just wondering if anyone else had some thoughts or was in the same boat. Thanks ahead of time for any comments.

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[b&ierstiefel]

I was wondering how heavily grades from the clinical years are weighed in to consideration for pathology residencies. I know I want to do pathology, I love the work, and I have a real talent (or at least I think I do) when it comes to pathology. It just seems to be the one area of medicine that came easy to me and I enjoy learning more about. The problem lies in years 3 and 4 of med school. I abhore certain things such as ob/gyn and psychiatry, and while I am not going to totally slack off on them, it is going to be hard for me to develop any interest in these rotations. So, I guess I am wondering if a top program (like the top 2 or 3) will count someone out if they only get a "pass" in a few rotations (versus high pass or honors), weighing in that I was top of my class the first 2 years, I have a borderline astronomical Step1 score (I am not trying to sound like an ass here at all, just trying to present the entire picture truthfully), and I plan on doing 2 away pathology rotations and working my a$$ off during those. Just wondering if anyone else had some thoughts or was in the same boat. Thanks ahead of time for any comments.

My feeling is that clinical grades can be important but aren't necessarily going to make or break your application if you have other strong points in your application. I keep hearing that pathology has gotten more competitive but the numbers don't seem to reflect that based on the ERAS data. I do hear that even though the # of applicants haven't dramatically changed, the quality of the applications themselves have improved. I think doing well on pathology rotations, making strong impressions, and securing good pathology letters can make a few "pass" grades during clinical rotations more forgiveable.

 

[Sean2tall]

I agree that clinical grades can be somewhat helpful, but you can't possibly control how they all turn out. If you try to do a good job and work hard and seem somewhat knowledgable, odds are you will get some "good" grades, but you might be surprised which ones. My OB eval explicitly said that I was sometimes disinterested and other comments were good but not necessarily glowing (shelf score was OK) and I ended up with honors. My psych comments were excellent (I think the attending generally gives quite good comments, I am no psych superstar) and again shelf was OK, but I ended up with pass. On surgery, some people (who want to do surgery) will kill themselves going to every case, etc. and others will do a moderate amount of work and get a better grade. So anyhow, I think the bottom line is if you do a decent job, you may even get good grades in those rotations you are not super interested in (even when the attendings know you are not going into that field).

Bierstiefel, I think it's interesting what you said about competitiveness of Path. If you just look at board scores, it does look like most specialties have similar averages 220's etc., but if you look at the % of people matching with low board scores, still 70% and above of Path applicants are matching with 200 and below, whereas with say ortho or derm, most people don't match with that kind of score. Anyhow, I take this to mean that you're right and Path has some strong applicants, but overall the field is still not highly competitive. Maybe this means that the most competitive Path applicants are competing for the top spots and that there is little competition for the weaker programs.

 

[mlw03]

as a side comment to the point of this thread, looking at the NRMP data for 2007 you see that there's about 320 american path applicants, 300 of them matched, 19 didn't, and the remaining 200 pgy-1 spots were filled by FMGs. i think that's very telling, and i think it supports sean's comments that the top places may be getting more competitive. however i think that data also implies that there are still far fewer american applicants than there are spots. now i think path is a specialty where a strong FMG who comes in with a PhD and plans for research can easily be more desireable than a US allopath grad, so it's not like all FMGs are less desireable. but assuming the number of applicants is about the same this year, i think it bodes well for us applicants.

to share my comments on the original question: MS3 grading is very subjective as sean pointed out, but the majority of students pull Bs in most rotations, and many comments posted on here in the past imply that's perfectly adequate for path. with a great step 1 score and away rotations at a place, i can't imagine having a pass in psych would significantly affect your candidacy.

 

[LAZYGUY]

if you look at the % of people matching with low board scores, still 70% and above of Path applicants are matching with 200 and below, whereas with say ortho or derm, most people don't match with that kind of score. Anyhow, I take this to mean that you're right and Path has some strong applicants, but overall the field is still not highly competitive.

To take it one step further. 14/19 (73%) of the AMGs who did not match into pathology had <3 ranked programs. 9/19 (47%) had <1 ranked program.

I guess programs are really wanting AMGs but you still need to rank enough programs to ensure a match.

 

[Sean2tall]

To take it one step further. 14/19 (73%) of the AMGs who did not match into pathology had <3 ranked programs. 9/19 (47%) had <1 ranked program.

I guess programs are really wanting AMGs but you still need to rank enough programs to ensure a match.

Ooh that's good. Thanks for pointing that out. My Step 1 is on the low side, so of course I am trying to remind myself that I will probably match if I get enough interviews.

 

[Neddy]

I was wondering how heavily grades from the clinical years are weighed in to consideration for pathology residencies. I know I want to do pathology, I love the work, and I have a real talent (or at least I think I do) when it comes to pathology. It just seems to be the one area of medicine that came easy to me and I enjoy learning more about. The problem lies in years 3 and 4 of med school. I abhore certain things such as ob/gyn and psychiatry, and while I am not going to totally slack off on them, it is going to be hard for me to develop any interest in these rotations. So, I guess I am wondering if a top program (like the top 2 or 3) will count someone out if they only get a "pass" in a few rotations (versus high pass or honors), weighing in that I was top of my class the first 2 years, I have a borderline astronomical Step1 score (I am not trying to sound like an ass here at all, just trying to present the entire picture truthfully), and I plan on doing 2 away pathology rotations and working my a$$ off during those. Just wondering if anyone else had some thoughts or was in the same boat. Thanks ahead of time for any comments.

Just remember that your clinical rotations are the best chance you'll have in your life to see what happens on the other end of the pathology report. Sure OB/GYN rotations can be a pain in the ass (mine was), but if you're genuinely enthusiastic with your team about learning the path-related stuff (cervical Ca screening, surgical triage of ovarian cysts, etc.) you might end up with a better grade than the guy who just pretends to like everything 'cus he's gunning for an all-honors dermatology application. Can't help you much with psych though.

 

[mlw03]

now all we have to do sean is get those interviews, eh!? think about this a little more: let's again assume 300 or so american applicants, and the bigger/top programs may interview 70-80 to fill their 8 spots (the ratio i found on FREIDA). also let's assume that 90% of those interviewees will be AMGs. that means the program would interview 25% of all AMG applicants - and presumably this big, strong programs are interested in the same chunk of applicants. so it certainly wouldn't be surprising to start seeing a lot of familiar faces on the interview trail (hopefully).

i would strongly agree with Neddy's comments about how to get the most out of MS3. i didn't hide my path interest and made a point of trying to focus on path-type stuff last year and it worked great. residents appreciated my interest when i said i wanted to review a patient's peripheral smear on peds to make sure her lymphocytosis was reactive and not full of blasts. the surgeons didn't mind when i followed frozen sections from the OR to path. as long as you're pulling your weight and not being annoying, most will give you some leeway, and when it comes to eval time you'll come across just fine - you don't have to be the super-psycho-interested gunner-type to succeed, i promise. also agree there's little path aspect in psych - just suck it up and enjoy the freak show that most psych floors are, and play a little game i like to call: who's crazier - the patients or the staff?

 

[DarksideAllstar]

It never hurts to be AOA on the interview trail (even path residencies covet those applicants, just like every other field), and I think at most places doing well during your clinical year is key to getting this. I also agree it is beneficial to see how patients are managed based on the scenario and the path report-- so try and pick up as much as you can.

 

[mm3781]

Thanks for all the replies, I have been telling my residents and attendings of my interest in pathology and it seems they sort of guage my performance a little differently, with maybe not as much weight on some things, which is good. And they now see why I am all about doing biopsies.

 

[Trenchcoat]

During my OB/GYN rotation I was kind of bored as well. There was a lot of downtime mixed with a lot of chaos. The best part was getting to autopsy a 21 week old spontaneous abortion on my own because I showed interest in it. There is plenty of path type stuff to do if you're vigilant and persistant. I pulled a decent grade in the rotation as well despite the shelf exam being brutal.