How do the Top 10 on the program's rank list get picked?

[deleted1139416]

Programs have to literally rank applicants from 1 to X. So, how exactly do programs select the top 1-10 people? And how do programs select between two applicant in a row (for example, how do you select between two applicants in terms of who gets #24 versus #25?). If they are the same, do you just default to ranking based on Step scores?

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[Billiam95]

Height

 

[deleted1139416]

Height

Nice try. Interviews are on zoom.

 

[voxveritatisetlucis]

Probably school prestige. Many programs love for their roster to be made up of grads from top schools

 

[RangerBob]

They assign points.

So many points for your STEP scores.
So many for clinical grades.
So many for your interviews.
Etc.
Then there's the "fudge points" like how much did the other residents like you, did one of the most respected attendings go to bat for you, etc

Add up the points--easy peasy.

The reality is PDs can never know everything about everyone in detail. "The Program" may rank you #4 instead of #5, but an all-knowing PD might have preferred it the other way around. But no PD is all-knowing, so they trust the opinions of their interviewers and the process they've developed.

PDs who obsess over who to rank #24 vs #25, and so on, will never get anything done. So they likely do a "good enough" job and move on with their lives. Presumably at worst they do the same thing the average med student does with our rank list. We obsess, then rank, re-rank, then final rank, then move on. PDs can do that too, but they have a full-time job to do (and maybe a family), so it's unlikely they have the time to be as neurotic as a 4th year med student on an elective rotation.

Small programs that interview just 10-15 people for 2 spots or whatever (ie, fellowship programs) are an entirely different ballgame, and ranking is far more, if not entirely dependent, on what the PD thinks.

 

[operaman]

Every program does this differently. We had each faculty and resident interviewer give a numeric score on various metrics. These were then averaged and that was our initial rank list. Following that, there was an official rank meeting where everyone would go through one by one and have to say if there was any good reason to make any adjustments along the way.

For the most part, adjustments were few. Any major red flags that came up could get someone DNR’d, while sometimes something compelling might get them bumped up.

For a program, the intricate details don’t matter much. Like for a program of 10 residents per year, the order of the first 10 is completely irrelevant. Even beyond that, the impact is negligible until you get to where you typically fill.

Contrast this with applicants’ lists where moving a program up one space may completely change where you end up.

 

[cj_cregg]

Different for every program and every specialty. At my program we took all faculty members' + chiefs' individually made rank lists into account to build the final rank list. Each person has different values and things they prefer for candidates, so there's not one single formula or factor that bumps someone up or down.

 

[Putkernerinthehall]

They assign points.

So many points for your STEP scores.
So many for clinical grades.
So many for your interviews.

How about pre-clinical grades and AOA? Are either of those significant factors?

 

[gyngyn]

How about pre-clinical grades and AOA? Are either of those significant factors?

It varies by specialty, program, region, applicant's school and the overall pool of applicants.

 

[RangerBob]

How about pre-clinical grades and AOA? Are either of those significant factors?

Everything is fair game. As gyngyn states, how programs take everything into account differs at any individual program.

Generally speaking, I would think preclinical grades are pretty low on the importance list.

 

[deleted1139416]

Every program does this differently. We had each faculty and resident interviewer give a numeric score on various metrics. These were then averaged and that was our initial rank list. Following that, there was an official rank meeting where everyone would go through one by one and have to say if there was any good reason to make any adjustments along the way.

For the most part, adjustments were few. Any major red flags that came up could get someone DNR’d, while sometimes something compelling might get them bumped up.

For a program, the intricate details don’t matter much. Like for a program of 10 residents per year, the order of the first 10 is completely irrelevant. Even beyond that, the impact is negligible until you get to where you typically fill.

Contrast this with applicants’ lists where moving a program up one space may completely change where you end up.

Thank you for the wonderfully detailed response! What are some things that can make an applicant DNR'd when it comes to ranking? Supposedly these applicants would have gotten the interview and passed through some filters.

 

[operaman]

Thank you for the wonderfully detailed response! What are some things that can make an applicant DNR'd when it comes to ranking? Supposedly these applicants would have gotten the interview and passed through some filters.

Very rare. Usually some kind of egregious inappropriate behavior during an interview or social. We’re talking things like overt intoxication, sexist/racist remarks, etc. And I’m talking real stuff, not what would get you mobbed on Twitter, but real good old fashioned inappropriate that would send a Gen Z’er running for a safe space.

Discovering false information on the application did it too. And often if there were whiffs of major issues, especially in strong applicants, we would reach out personally to friends at their med school, either faculty or sometimes even fellow students if someone had a connection. Sometimes the word of mouth would get them off the list or at least way down into won’t match range.

By the interview point you really have to try. 99% of people are normal humans. Just don’t lie on your application, don’t get hammered, don’t say or do anything you wouldn’t say or do in front of your mother and grandmother, and all is well. A little social awkwardness doesn’t get solid applicants booted; we’re all a little bit weird to do this crazy job in the first place. Just be a nice normal human.

 

[gyngyn]

What are some things that can make an applicant DNR'd when it comes to ranking? Supposedly these applicants would have gotten the interview and passed through some filters.

Don't forget being rude to the PC or anyone who works in the hospital (parking attendant, security guard, information booth...).
Comments made in the elevator when you think it's just the other interviewees ("this is just my backup"...) are also a good way to get DNR'ed.

 

[Putkernerinthehall]

It varies by specialty, program, region, applicant's school and the overall pool of applicants.

Any idea which specialties might weigh pre-clinical and AOA more heavily?

 

[gyngyn]

Any idea which specialties might weigh pre-clinical and AOA more heavily?

Surgical subs that have way too many over-qualified candidates and IM at research powerhouses.

 

[operaman]

Don't forget being rude to the PC or anyone who works in the hospital (parking attendant, security guard, information booth...).
Comments made in the elevator when you think it's just the other interviewees (this is just my backup...) is also a good way to get DNR'ed.

Oh seconding this 110%

When we interviewed, literally all our clinic staff would help out with the logistics on interview days and we definitely had a few candidates that would be rude to them. Again, not something minor, but flat out jaw dropping rude. Needless to say they too had input on ranking and would pass these experiences on to the rest of us. Some applicants apparently don’t realize that our admin and clinic staff are the lifeblood of our enterprise and we couldn’t function without them. Many have been there for decades and seen hundreds of trainees come and go. I think every attending on the planet will side with their staff over an applicant any day.

Again as I mentioned above, people just need to be normal humans. It’s not hard. Just basic manners. But yea assume everyone you meet is ranking you and treat them accordingly.

 

[deleted1065184]

Can anybody explain how programs that rank based on points adjust for schools where there are no grades or AOA? I know an adjustment is made, but just curious to know how.

 

[Esmolol]

Oh seconding this 110%

When we interviewed, literally all our clinic staff would help out with the logistics on interview days and we definitely had a few candidates that would be rude to them. Again, not something minor, but flat out jaw dropping rude. Needless to say they too had input on ranking and would pass these experiences on to the rest of us. Some applicants apparently don’t realize that our admin and clinic staff are the lifeblood of our enterprise and we couldn’t function without them. Many have been there for decades and seen hundreds of trainees come and go. I think every attending on the planet will side with their staff over an applicant any day.

Again as I mentioned above, people just need to be normal humans. It’s not hard. Just basic manners. But yea assume everyone you meet is ranking you and treat them accordingly.

That's why my MO always has been that once you park three blocks away from your interview spot, you're being interviewed/watched until you drive off at the end of the day...

 

[gyngyn]

Can anybody explain how programs that rank based on points adjust for schools where there are no grades or AOA? I know an adjustment is made, but just curious to know how.

Step 2 gets all the points.

 

[Goro]

Any idea which specialties might weigh pre-clinical and AOA more heavily?

Check out the Program Directors guide.

 

[Putkernerinthehall]

Check out the Program Directors guide.

From the specific program's website or some other link that aggregates this stuff?

 

[operaman]

That's why my MO always has been that once you park three blocks away from your interview spot, you're being interviewed/watched until you drive off at the end of the day...

Not sure if it’s true or myth, but I’ve heard a tale of someone who was a royal —-hole to a gate agent at the local airport. It was a smaller town and a small airport and somewhere along his ranting the dude let it slip that he was applying for residency and the gate agent happened to know someone in the program and passed along her impression of him as well. So I would consider expanding that radius in smaller cities especially just to be safe!

You can remediate and retrain a lot of deficiencies, but basic personality and manners are nearly impossible to train. All those things we learned in kindergarten. If they aren’t habitual 20 years later, probably not gonna change during training either. ENT in particular is known for kind happy people so I think we are especially protective and wary of ——holes!

 

[mrbreakfast]

What are some things that can make an applicant DNR'd when it comes to ranking?

Many posts on this topic on SDN. But as noted above, this is exceedingly uncommon, for truly egregious behavior. Examples I've seen/heard of include making racist remarks, lambasting the program at which you're interviewing, espousing extremist political views during your interview, or getting absolutely hammered at the interview dinner and aggressively hitting on the female residents.

Medical schools accept plenty of people with lots of brains and zero common sense, some of whom have never really interacted with society or held an "adult" conversation for more than a few minutes. There are arrogant jerks who've made it this far due to having brilliant CVs, and those people often will match; but, plenty of programs won't take them. You can fix bad grades or bad habits, but can't fix a bad personality.

 

[GoSpursGo]

As others have said, it completely varies from one program to the next. Some programs are very regimented and assign points to arrive at a final rank. In other situations, like the fellowship program in a noncompetitive subspecialty where I currently practice, the PD takes all of the interview feedback alongside whatever objective data we have, and creates their own personal ROL. All the faculty then review together, and we have a chance to advocate to move people up or down. Then the PD has the final say.

So on one extreme of the spectrum you have some programs that try to put this down to a science, and some other programs where it literally is all subjective after they decide you're good enough to interview. You won't know which programs are which.

 

[cj_cregg]

From the specific program's website or some other link that aggregates this stuff?

I'm on my phone and can't pull it up/link it easily, but it is the NRMP program director survey if you just Google that!